Dialysis Quiz

A 58-year old man who has chronic kidney disease secondary to nephrosclerosis has received hemodialysis for five years. During the past three months, progressive ascites has developed. Testing has ruled out cirrhosis, Budd-Chiari syndrome, congestive heart failure, and pericardial disease.

Physical examination shows ascites and only trace peripheral edema. He has no stigmata of cardiac or liver disease. Diagnostic paracentesis yields yellow fluid with a leukocyte count of 50/mm³(predominantly lymphocytes), protein of 5.5 g/dL, and albumin of 2.2 g/dL (serum albumin is 3 g/dL); amylase level is low. Peritoneal fluid cultures, including for tuberculosis, show no growth.

Which of the following will most likely resolve the ascitic condition?

A. Aggressive daily dialysis

B. Conversion to peritoneal dialysis

C. Peritoneal-venous shunt

D. Transjugular intrahepatic portosystemic shunt (TIPS)

E. Kidney transplantation