Impaired peritoneal fluid drainage in nephrogenic ascites.

In three chronic hemodialysis patients with nephrogenic ascites and in four patients with ascites of other causes the rate of transfer of fluid from peritoneal cavity to plasma was measured by a radio-labelled albumin method. Ascitic fluid removal rate was lower in the patients with nephrogenic ascites (median 14, range 10 to 21 ml/hr) than in those with normal renal function (median 45, range 10 to 73 ml/hr). These results suggest that lymphatic drainage of the peritoneum is impaired in nephrogenic ascites and that this may contribute to the development of the condition and to the propensity of fluid overloaded dialysis patients to develop ascites. A retained substance or one liberated from abnormal kidneys may be responsible for reversible depression of lymphatic flow in uremia.