Cirrhosis Support Group

I found this and thought it might be helpful...

http://kidney.niddk.nih.gov/kudise...

Obviously I am extremely interested since Brian has difficulty controlling his ascites. Because of his HRS-2 (hepatorenal syndrome: type 2) he is limited as to how much diuretics he can safely use. I am looking forward to other members opinions or experiences.

Hey,
It looks like it is just for dialysis, not for draining of ascites fluid.

This is from wikipedia, there is no mention of ascites of liver problems.......

Current treatment options for patients with severe chronic kidney failure are dialysis and kidney transplantation. Dialysis is a treatment that removes substances such as water, salts, and waste products (from the body’s normal metabolism), which build up in patients with failing kidneys. There are two forms of dialysis. One is called hemodialysis (HD), where the blood is cleaned outside the body and then returned to the body. This treatment, done in a hospital, or a dialysis clinic, is normally done 3 times a week, where each session takes about 3.5-4 hours. In HD, a machine and a filter (dialyzer)are required, as well as a system to get the blood out of the body, as well as returning the cleaned blood to the patient. In most patients, this so called access to the blood, is done by inserting two needles into an access in one of the patient's extremities. A fistula is when an artery and a vein are connected during surgery. A graft is a piece of "tubing" that connects the vein and the artery. Or a central venous catheter(permcath)is inserted into the patients chest, groin or leg to provide an access for the dialysis treatment.
[edit]What is peritoneal dialysis (PD) and how does it work?

The other form of dialysis is called peritoneal dialysis (PD). More than 150,000 patients are currently receiving this lifesaving treatment around the world.
In PD, a dialysis fluid is entered into the patient’s abdominal cavity (the “belly”), which is covered by a thin membrane, containing many small blood vessels. This membrane, called the peritoneum, is like a big bag that contains much of the intestines, helping to keep them in place. The dialysis fluid will make water, salts, and the waste products move from the blood into the fluid (also called solution). This process is called dialysis, and means that the peritoneum works as a dialysis filter. As the fluid gets saturated after a while, the solution must be exchanged regularly (see below).
The solutions
The fluids contain either sugar (glucose), amino acids, which are building blocks for proteins, or a compound called icodextrin, to remove the water. The sugar solution is the one most commonly used. The glucose “strength” (1.5%, 2.5% or 4.25%) of the solution determines how much water is removed from the blood; the higher the concentration, the greater the water removal. The amino acid solution is used to improve a patient’s nutritional condition (as the amino acids are taken up by the body, i.e. they move from the solution to the blood), and/ or to reduce the uptake of glucose from the solution. The benefits of the icodextrin fluid is that it removes more water than the glucose solution for longer exchange intervals, and that it is glucose- free, which is advantageous both for the peritoneum and the body as a whole.
There are two types of glucose solutions. The main difference is the pH, and the type of substance added to reduce the acidity of the blood, which is common in patients with kidney disease.
How can the solution be exchanged?
A small plastic tube, called a catheter, which has been placed through the abdominal wall in a small operation done before starting PD, is used to let the fluid go in to, and out from, the abdomen. The place where the catheter comes out is called the “exit site”. The catheter can normally be used for many years if so needed. In most cases two liters of fluid is entered each time, and is exchanged 4 times per day. In the beginning the patient may feel some discomfort when the solution goes in, but this normally disappears after a while. The bags are delivered to the patient’s home at regular intervals.
Preparation for the exchange
The recommended procedure varies somewhat between centers, but in most cases the patient wears a disposable surgical mask, and scrubs the hands for 3 minutes using soap and water. The solution should be warmed to body temperature before use, for example by using a heating pad or a heating plate. Many centers will provide the patients with an appropriate heating device to be used at home.

I'm heading out the door but, I wanted to suggest that you so a search of 'Peritoneal Dialysis in Cirrhotic Patients with Ascites.' I came across many links but, I simply don't have time to decipher any of it at the moment. I'm sorry. I'll try to take a look when I get back and let you know what I find. Or, if you beat me to it, let me know what you find, lol.

Best of luck and prayers to you and Jim.

Found this.......

PERITONEAL DIALYSIS IN THE COMPREHENSIVE MANAGEMENT OF END-STAGE RENAL DISEASE PATIENTS WITH LIVER CIRRHOSIS AND ASCITES: PRACTICAL ASPECTS AND REVIEW OF THE LITERATURE

The treatment of cirrhotic patients with ascites and end-stage renal disease is complex, due mainly to decreased effective arterial volume and hemodynamic instability. Peritoneal dialysis as a continuous therapy represents an alternative to hemodialysis-related intolerance. We report on our experience and that of others with cirrhotic patients with ascites treated by peritoneal dialysis. Hemodynamic tolerance was excellent in all patients and solute and water peritoneal transport increased to above the normal range in almost all cases. Morbidity and mortality were related principally to liver disease and other comorbidities. Peritoneal protein losses, initially high, decreased over time, maintaining serum albumin within the low normal range. The incidence of peritonitis was similar or slightly higher than usual in these patients, with peculiar etiology. The experiences with peritoneal dialysis suggest consideration of this treatment as the first choice for cirrhotic patients with ascites and that need to start dialysis.


KEY WORDS: Ascites; liver cirrhosis; end-stage renal disease.

Thanks guys. I'll keep looking also and let you know what I find.

Craig, what would we do without you and your nose for research ?? :) hugs, hugs and more hugs!

Ask Nicci instead!!! :-)

Karen I`ve read about this before, it is NOT what Jim needs. What I believe he`s talking about is the bypass under the skin of the chest I told you about (I think). Note to self; start a chart on Jim!
Also beware of wikipedia it`s great for baseball stats not so good for medical advice. Anyone can make changes to wikipedia.

Perhaps I should run everything past Jeff before posting anything??
Or just not bother............

Posting that is.......

Ok guys. Is this just friendly ribbing or p___ing contest between you two? I appreciate the advice from EVERYONE. It gives me things to think about.