Evaluation of an ascites pump for refractory ascites in patients on hemodialysis (HD)

Abstract

An ascites pump (peritoneo-venous shunt pump), implanted in HD patients with refractory ascites, was evaluated for its utility.
Four male and one female HD patient ranging from 44 to 67 years of age, who had persistent ascites in spite of conservative therapy were evaluated. The etiologies of ascites were liver cirrhosis (3), nephrogenic (1) and unknown (1).
An ascites pump was implanted in these patients between 1991 and 1994. The ascites pump was composed of an ascites collector, a flush bulb, and an infusion catheter. The ascites collector was located in the peritoneal cavity and the infusion catheter was inserted in the external or internal jugular vein under local anesthesia. Ascitic fluid was drained through the pump implanted underneath the skin.
Mean body weight and abdominal girth decreased significantly (p<0.05) after the pump implantation and improvements in the quality of life were obtained in four patients. Total serum protein and albumin concentrations increased significantly. One patient has been alive for three years without ascites and four of the five patients died of their underlying disease.
In one patient, the postoperative course was complicated by the catheter slipping out of the vein and there was one wound infection. Gabexate mesilate was effective in preventing DIC. Frequent HD following pump implantation was employed to avoid pulmonary edema during the early postoperative period. Thus, no severe complications such as DIC or pulmonary edema occurred. Our results indicate that implantation of the ascites pump was a safe and effective method of treating HD patients with refractory ascites.