Patients with refractory ascites due to advanced liver disease, intra abdominal malignancy, end stage renal disease(ESRD) and severe heart failure are on multiple diuretics/repeated large volume paracentesis sessions, however they are not getting symptomatic relief and also getting side effects like dyselectrolytemia/worsening residual renal function due to diuretics, they are also getting bacterial peritonitis due multiple large volume paracentesis(LVP) sessions.We subjected some of these patients to ascitic fluid ultrafiltration (AFU) to see the clinical benefits.

AFU was done in 12 patients.They were subjected to 14F pigtail catheter placement in peritoneal cavity, run the ascitic fluid at a speed of 120ml/min through blood pump/lowflux dialyser/conventional hemodialysis machine/keep the blood clamp at air detector off/keep the dialysate off during the procedure.Targeted fluid removed in each session was 3000ml to 4000ml.

Figure 1

AFU therapy is safe, not associated with side effects, improves residual renal function, improves ejection fraction, improves QOL, decreases diuretic requirement and decreases hospital visit for LVP sessions. It decreases the albumin and other protein loss that occur during LVP sessions. It deceases the need for hemodialysis and act as a bridge therapy to facilitate liver transplantation in patient with advanced liver disease.