Dialysis-Associated Ascites: Leave No Stone Unturned
- Home Dialysis - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
- Sharma, Prerna, Maine Medical Center, Portland, Maine, United States
- Segal, Alan, Maine Medical Center, Portland, Maine, United States
Dialysis-associated ascites (DAA) is a rare complication of ESRD, with a pathogenesis that is poorly understood. Here, we present a case of DAA that developed in a patient after starting home hemodialysis.
A 54-year-old man with a rare genetic renal-limited neoplasm eventually had all kidney tissue removed and went on HHD using NxStage via an AVF. Shortly thereafter, he developed large ascites that required paracentesis (~8 L) every 6-8 weeks, and also developed sexual dysfunction and restless leg syndrome (RLS). Cardiac function and hepatic synthetic function remained normal and he had no edema. The ascites was exudative with a serum:ascites albumin gradient less than 1.1. Cytology was always negative. After 4 years on HHD, he received a kidney transplant that had to have a ureteral stone removed just prior to transplant. Within 48 hours of transplant, his DAA completely resolved and over the next 6 weeks his sexual dysfunction and RLS also resolved. In the 8 years since his transplant, he has never developed nephrolithiasis and continues to enjoy essentially normal kidney function.
DAA is said to carry a poor prognosis with a mortality rate of 45% over 15 months. The pathogenesis is unclear, but hypoalbuminemia is thought to be a contributing factor. Patients usually present with severe, worsening and recurrent ascites, and cachexia. It is considered generally refractory to the usual treatment modalities and remains largely a diagnosis of exclusion. Kidney transplantation is the only definitive treatment with resolution of the ascites usually occurring over 6 weeks. In our patient, who was anephric due to a very rare renal-limited neoplasm, the ascites was mobilized immediately and resolved in 48 hours, and his other symptoms resolved within 6 weeks. Although his transplant kidney came from a stone-former, he is not a stone former and has never had nephrolithiasis. We conclude that although being anephric may increase the risk of DAA, it can rapidly resolve with transplantation so the prognosis may not be as grave if transplant can be expedited.