Continuous Ambulatory Peritoneal Dialysis for Refractory Ascites in Chronic Liver Disease and ESRD: Feasibility, Safety, and Clinical Outcomes

Background: Refractory ascites in patients with chronic liver disease (CLD) and end-stage renal disease (ESRD) presents high morbidity. Hemodialysis (HD) often complicates fluid removal due to intradialytic hypotension. Continuous Ambulatory Peritoneal Dialysis (CAPD) is a potential alternative, but data on its suitability in this cohort are limited. This study evaluated serum albumin changes, peritonitis rates, and overall CAPD suitability in CLD patients with refractory ascites transitioning from HD. Methods: This retrospective cohort study (Jan 2018-Mar 2023) included adult HD patients (≥6 months) with CLD and refractory ascites (>5 paracenteses/last 3 months despite optimal management). Patients received high-protein diet counseling and regular multidisciplinary follow-up. Results: Thirty-four patients were analyzed. Pre-CAPD, mean ascites drainage was every 3.4 weeks. At 12 months on CAPD, serum albumin non-significantly increased from 2.98 ± 0.4 g/dL to 3.1 ± 0.28 g/dL (p=0.21). (Figure 1) Child-Pugh and MELD scores remained stable. Bacterial peritonitis incidence at 12 months was higher (p=0.04) compared to baseline spontaneous bacterial peritonitis on HD. Manageable PD-related complications included one omental wrap, three pericatheter leaks, and one umbilical hernia. At 12-month follow-up, 94.1% (32 patients) survived; one death was from myocardial infarction, another from severe hepatic encephalopathy/aspiration pneumonia. Conclusion: CAPD was well-tolerated in CLD patients with refractory ascites, without worsening hypoalbuminemia. Continuous multidisciplinary monitoring for malnutrition is crucial. While peritonitis risk was elevated compared to SBP on HD, it was comparable to typical PD rates and did not increase hospital admissions, suggesting CAPD is a viable management strategy. Funding: Clinical Revenue Support