The effects of dialytic ultrafiltration and peritoneal reinfusion in the management of diuretic resistant ascites.

Six patients with alcoholic liver disease and massive ascites were treated by dialytic ultrafiltration and peritoneal reinfusion of their ascitic fluid. Immediately after the procedure there was significant improvement in cardiac output (5.2 +/- 0.4 to 5.9 +/- 0.4 L/m, p less than 0.05) and stroke volume (53 +/- 5.5 to 62 +/- 4.7 ml/beat, p less than 0.02) with no change in heart rate or blood pressure, right atrial, pulmonary artery, or wedge pressures. Serum creatinine and serum electrolytes were stable. Ascitic fluid albumin rose significantly immediately after the procedure (1.5 +/- 0.2 to 2.9 +/- 0.5 g/dl, p less than 0.001) with gradual improvement in serum albumin (2.9 +/- 0.3 to 4.1 +/- 0.2 g/dl, p less than 0.05) in 3 months. Plasma renin (26.9 +/- 9.6 to 17.9 +/- 6.3 ng/ml/h, p less than 0.05) and plasma aldosterone (67 +/- 18 to 39 +/- 11 ng/dl, p less than 0.01) fell significantly immediately after the procedure. No serious side effects were noted and liver function remained stable. Four of six patients followed for 3-14 months could be managed on lower doses of diuretics.