Recurrent Ascites in Hemodialysis Patients: Clinical Features, Causes and Outcomes

The study aims to determine prevalence and describe the clinical characteristics, causes and outcomes of hemodialysis patients with recurrent ascites. The study involved multiple hemodialysis centers both hospital-based and free-standing units, and the data was collected from January 2018 to June 2023. All patients on maintenance hemodialysis (at least 3 months) and age > 18 years with recurrent ascites (three or more episodes of ascites within a 12-month period) were included. Frequencies and percentages were computed for different categorical variables. There were 32 individuals with recurrent ascites out of the total 279 hemodialysis patients (11.4%). Based on their baseline characteristics (Table 1), there was a higher proportion of males and glomerulonephritis as the cause of the end stage renal disease in the recurrent ascites group. Hemodialysis patients without recurrent ascites have a significantly higher proportion of diabetes as the etiology of kidney disease. Based on their initial ascitic fluid analysis, the most common cause of the recurrent ascites was nephrogenic, followed by congestive heart failure. There were slightly more individuals with low serum ascitic albumin gradient. Only 4 patients (12.5%) had a positive bacterial culture while 2 patients were diagnosed with tuberculosis based on Gene Xpert testing. There is no difference as to the proportion of hospitalizations and mortality among those with and without recurrent ascites. Recurrent ascites is a common finding among hemodialysis patients. The end stage kidney disease still accounts for most of the causes. While it did not cause additional harmful risk, it causes discomfort and difficulty among patients. The need for other management options beside repeated paracentesis is still wanting.