Is CAPD Feasible for Cirrhotic Patients with Refractory Ascites?

Background Hemodialysis (HD) in patients with cirrhosis often poses several challenges. Continuous ambulatory peritoneal dialysis (CAPD) has emerged as an alternative, particularly those with refractory ascites. However, concerns regarding hypoalbuminemia, peritonitis, and long-term outcomes remain. Materials and Methods This retrospective, single-center study included 34 cirrhotic patients with refractory ascites on maintenance HD who underwent CAPD catheter placement between January 2018 and March 2023. Clinical, biochemical, and procedural data were collected, including ascites management protocols, nutritional status, and peritonitis episodes. Primary outcomes included patient survival, peritonitis rate, and changes in serum albumin over 12 months. Results The mean follow-up was 12±2.1 months, and 94% survived at 1 year. Two transitioned to HD due to ultrafiltration failure after episodes of peritonitis. The peritonitis rate was 1 episode/45 patient months. A modest initial decline in serum albumin (-6%) occurred during the first 2 months of therapy, which later stabilized. Mechanical complications, pericatheter leaks, omental wrapping requiring omentopexy, and one umbilical hernia, were managed with a combination of conservative measures and minor invasive procedures as indicated. Conclusion CAPD is a feasible and effective modality for ESKD patients with refractory ascites, offering high 1-year survival, stable serum albumin levels, and acceptable peritonitis rates when compared to standard peritoneal dialysis (PD) cohorts.