Practice and Outcome Trends of Peritoneal Dialysis in Chronic Kidney Disease Patients With Liver Cirrhosis and Chronic Heart Failure Complicated by Symptomatic Ascites-A Scoping Review

BackgroundThe rising growth of patients with end-stage kidney disease (ESKD) associated with chronic liver disease (CLD) and refractory chronic heart failure (CHF) associated with advanced chronic kidney disease (CKD) complicated by ascites presents serious renal replacement therapy (RRT) challenges. Haemodialysis is often poorly tolerated owing to increased hemodynamic instability, bleeding, and encephalopathy risks. Peritoneal dialysis (PD) has emerged as a promising alternative, but its adoption and efficacy are not consistently supported by existing literature, and there lacks guideline consensus.MethodsWe thus used a scoping review approach to more accurately map the literature on PD practice and outcomes in this population.ResultsWe identified 18 observational studies involving 627 ESKD patients with CLD/ascites and 222 advanced CKD patients with CHF/ascites. We found practice patterns revealing higher adoption of PD for CLD/ascites in Asia, reflecting the heavier regional PD and viral hepatitis penetration, while there was unique usage for CHF in Western settings. Across contexts, PD demonstrated adaptability for diverse patient profiles. PD as urgent-start and incremental therapy enabled both long-term controlled paracentesis and dialysis while maintaining haemodynamic stability, optimal nutritional status and particularly in CHF improved symptom control, reduced hospitalisation, and lowered diuretics reliance. Mechanical complications were rare and typically manageable whilst peritonitis rates were comparable without impacting technique failure. Survival outcomes were also comparable or superior.ResultsWe identified 18 observational studies involving 627 ESKD patients with CLD/ascites and 222 advanced CKD patients with CHF/ascites. We found practice patterns revealing higher adoption of PD for CLD/ascites in Asia, reflecting the heavier regional PD and viral hepatitis penetration, while there was unique usage for CHF in Western settings. Across contexts, PD demonstrated adaptability for diverse patient profiles. PD as urgent-start and incremental therapy enabled both long-term controlled paracentesis and dialysis while maintaining haemodynamic stability, optimal nutritional status and particularly in CHF improved symptom control, reduced hospitalisation, and lowered diuretics reliance. Mechanical complications were rare and typically manageable whilst peritonitis rates were comparable without impacting technique failure. Survival outcomes were also comparable or superior.ResultsWe identified 18 observational studies involving 627 ESKD patients with CLD/ascites and 222 advanced CKD patients with CHF/ascites. We found practice patterns revealing higher adoption of PD for CLD/ascites in Asia, reflecting the heavier regional PD and viral hepatitis penetration, while there was unique usage for CHF in Western settings. Across contexts, PD demonstrated adaptability for diverse patient profiles. PD as urgent-start and incremental therapy enabled both long-term controlled paracentesis and dialysis while maintaining haemodynamic stability, optimal nutritional status and particularly in CHF improved symptom control, reduced hospitalisation, and lowered diuretics reliance. Mechanical complications were rare and typically manageable whilst peritonitis rates were comparable without impacting technique failure. Survival outcomes were also comparable or superior.ConclusionsOur findings add valuable insights to PD as a feasible and safe long-term RRT option across the ascitic CKD spectrum. Broader consensus is nonetheless needed on its expansion as a first-line therapy and bridge to both palliation and transplantation.