Abstract
Liver cirrhosis is an advanced stage of chronic liver disease, sometimes complicated with refractory ascites and/or spontaneous bacterial peritonitis(SBP). Continuous ambulatory peritoneal dialysis(CAPD)has been reported to be effective for end-stage renal disease(ESRD) patients with liver cirrhosis and ascites. However, there is insufficient information on the long-term outcome of CAPD therapy for patients with liver cirrhosis. We encountered two Japanese patients in whom CAPD therapy was initiated due to liver cirrhosis with ascites. A 49 y.o. male patient started CAPD, because of uremia due to transplanted kidney failure and refractory ascites. Initially, he demonstrated hyponatremia and hypoalbuminemia, which were resolved by the increased intake of salt and protein using branched-chain amino acids. However, hypotension persisted because of decreased peripheral vascular resistance with a hyperdynamic circulatory state associated with liver cirrhosis. Finally, he died of circulatory failure due to peritonitis after 16 months of CAPD therapy. A 74 y.o. male with diabetic nephropathy and idiopathic liver cirrhosis accompanied by ascites developed recurrent peritonitis mainly caused by E. coli after sclerotherapy of esophageal varices after 40 months of CAPD therapy. We changed therapy from CAPD to hemodialysis(HD) in order to prevent peritoneum sclerosis because we diagnosed this patient as having SBP-associated liver cirrhosis. He died of the progression of hepatic failure after 7 months of HD therapy. In this report, we also summarized 15 Japanese ESRD cases showing liver cirrhosis treated by CAPD, and discuss the advantages and disadvantages of CAPD therapy for these cases.
