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Kidney Week

Abstract: PO0131

Using a Peritoneal Dialysis Catheter as a Tool for AKI Prevention in a Patient with Refractory Cardiac Ascites: A Case Report

Session Information

Category: Trainee Case Report

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Rashid, Raja Muhammad, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
  • Mahdi, Amar Monaf, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
Introduction

Recurrent large volume paracentesis (LVP) is currently the followed management option for refractory cardiac ascites. We are presenting a case where placement of tunneled peritoneal catheter (PD) for such a patient resulted in prevention of repeated AKI, reduced hospitalization, dramatic improvement in quality of life and stabilization of renal function.

Case Description

59 year old male patient of CKD ¾ secondary to Cardio-Renal syndrome was admitted in Apr 2019 with worsening heart failure, massive ascites and AKI on CKD (Serum Creatinine (cr) worsening from 150 to 210 umol/L). His last echo showed severely impaired biventricular dysfunction with LVEF of 24%. Ascites was sterile and transudative. Kidneys were of normal size and urine PCR was only 20. Owing to poor diuretic response, he underwent LVP (30 Litres) with resolution of AKI. He presented similarly in Nov 2019 (Cr worsened from 197 to 550umol/l) and underwent LVP. 6 weeks later, he presented again with AKI (Cr rose from 190 to 380 umol/l). PD catheter was medically inserted in Jan 2020. 8 litre of ascites was drained and patient was trained to aseptically drain the ascites regularly. He drained the fluid himself 2 to 3 L twice a week. His Cr improved and stabilized around 157 umol/l. His serum albumin (29to 40 g/l), Hb (77 to 135 g/l), quality of life, blood pressure and diuretic response has improved significantly with body weight maintained at 83 kg. He has not been admitted once in past 5 months.

Discussion

Our patient was having repetitive AKI (known cause of CKD progression) due to worsening congestion and possibly raised intra-abdominal pressure( IAP). Increased systemic venous pressure can cause a decline in GFR by increasing renal interstitial pressure. Venous congestion also causes an inflammatory response within the renal parenchyma.Clinical parameters improved once the gentle PD catheter drainage was instituted at home. No further AKI episode was observed and eGFR was stabilized.