Hemodialysis-associated ascites

Q: Hemodialysis-associated ascites usually has a high protein content.

A) True

B) False

Answer: A

 Hemodialysis-associated ascites is also known as nephrogenic ascites. One unique feature of hemodialysis-associated ascites is a high protein content, i.e.,3-6 g/dL, but simultaneously low serum ascites albumin gradient (SAAG). Despite its high protein content, it is usually clear in appearance. 

Hemodialysis-associated ascites is distinct from other causes of ascites and is a diagnosis of exclusion. Pathophysiology is not properly known and is also called idiopathic dialysis ascites. It is assumed that cause is chronic hepatic congestion, changes in the peritoneal membrane permeability, and impaired lymphatic peritoneal resorption. As expected, it is more common in patients who are on chronic peritoneal dialysis.

#hepatology

#nephrology

#GI

References:

1. Hammond TC, Takiyyuddin MA. Nephrogenic ascites: a poorly understood syndrome. J Am Soc Nephrol 1994; 5:1173.

2. Holm A, Rutsky EA, Aldrete JS. Short- and long-term effectiveness, morbidity, and mortality of peritoneovenous shunt inserted to treat massive refractory ascites of nephrogenic origin analysis of 14 cases. Am Surg 1989; 55:645.

3. Feingold LN, Gutman RA, Walsh FX, Gunnells JC. Control of cachexia and ascites in hemodialysis patients by binephrectomy. Arch Intern Med 1974; 134:989.

4. Melero M, Rodriguez M, Araque A, et al. Idiopathic dialysis ascites in the nineties: resolution after renal transplantation. Am J Kidney Dis 1995; 26:668.