Hemodynamic improvement after peritoneovenous shunting in nephrogenic ascites.

A patient being treated by regular hemodialysis for end-stage renal failure had nephrogenic ascites. Despite attempts at fluid removal by ultrafiltration, progressive hypotension and low cardiac output eventually reduced fistula flow so much that hemodialysis became almost impossible. The insertion of a peritoneovenous shunt resulted in reduction of ascites and 78% increase in cardiac output, with consequent correction of hypotension and improvement of fistula flow. Peritoneovenous shunting is a simple and beneficial form of treatment for nephrogenic ascites that does not respond to fluid removal by dialysis.