Incidence of Hyponatremia in Patients With Indwelling Peritoneal Catheters for Drainage of Malignant Ascites

Gupta, Shruti; Tio, Maria Clarissa; Gutowski, Emily D.; Stecker, Michael S.; Verma, Ashish; Motwani, Shveta S.; Mount, David B.; McMahon, Gearoid M.; Waikar, Sushrut S.

doi:10.1001/jamanetworkopen.2020.17859

Cited by 7 publications

(5 citation statements)

References 22 publications

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“…However, there are currently no studies that investigated the safety of ascites removal in a daily manner. Another study also reported a high hyponatraemia incidence of almost 85% in patients with PeCa and malignant ascites 34 . Ascites sodium levels are often comparable to serum sodium levels and removing 1litre of ascites at a sodium level of 135 mmoL/L results in a total sodium loss of over 3 g/L.…”

Section: Discussionmentioning

confidence: 92%

“…Another study also reported a high hyponatraemia incidence of almost 85% in patients with PeCa and malignant ascites. 34 Ascites sodium levels are often comparable to serum sodium levels and removing 1litre of ascites at a sodium level of 135 mmoL/L results in a total sodium loss of over 3 g/L. Daily removal of larger quantities of ascites could therefore trigger an absolute hyponatraemia.…”

Section: Discussionmentioning

confidence: 99%

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Home‐based, tunnelled peritoneal drainage system as an alternative treatment option for patients with refractory ascites

Tergast

Griemsmann

Stockhoff

et al. 2022

Aliment Pharmacol Ther

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Summary Background Onset of refractory ascites is the hallmark of end‐stage liver disease. If liver transplantation (LTx) is not available and contraindications for a transjugular portosystemic shunt (TIPS) are present, repeated paracentesis remains the standard of care (SOC). Home‐based, tunnelled peritoneal catheters (PeCa) have been suggested as an alternative treatment option. However, data on patients with cirrhosis are scarce. Aim To evaluate the safety of PeCa in these patients compared to SOC. Methods Overall, 223 patients with cirrhosis, a contraindication for TIPS and refractory ascites were included in this retrospective study. PeCa implant was performed in 152 patients, whereas 71 were treated with SOC. Analysed end points included device explant‐free survival, mortality, acute kidney injury (AKI) and hyponatraemia. In the second approach, propensity score matching (PPSM) was performed to adjust for confounding factors. Results In patients with PeCa, median device explant‐free survival was 74 days and 52 explants were recorded within the first 90 days. Within 90 days, patients with PeCa had lower mortality than SOC (p = 0.11), and spontaneous bacterial peritonitis (SBP) incidence did not differ (p = 0.82). Regarding AKI and hyponatraemia, there was a trend towards a higher incidence in the PeCa group (p = 0.13 and p = 0.08), and the risk for rehospitalisation was higher in those with a PeCa (HR: 2.11, p = 0.04). After PPSM, mortality was lower in the PeCa group (HR:0.40; p = 0.03), whereas the incidence of SBP and hyponatraemia was comparable (p = 0.80 and p = 0.28) and AKI was more frequent in those with a PeCa (p = 0.08). Conclusion The implant of PeCa allows home‐based therapy of patients with cirrhosis and refractory ascites and a contraindication for TIPS. However, the risk for complications has to be considered and prospective studies are needed.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Home‐based, tunnelled peritoneal drainage system as an alternative treatment option for patients with refractory ascites

Tergast

Griemsmann

Stockhoff

et al. 2022

Aliment Pharmacol Ther

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“…Salt restriction of 2 to 3 g/d is recommended in individuals with ascites . However, device-associated desalination has been described in patients with malignant neoplasm–related ascites and patients present with (intravasal) hypovolemic hyponatremia . Since ascites and serum contain similar amounts of sodium, drainage of 1.5 L/d or more leads to a sodium loss of more than 4.5 g/d, if the serum sodium is higher than 135 mmol/L .…”

Section: Discussionmentioning

confidence: 99%

Daily Low-Volume Paracentesis and Clinical Complications in Patients With Refractory Ascites

et al. 2023

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ImportanceThe potential association of low-volume paracentesis of less than 5 L with complications in patients with ascites remains unclear, and individuals with cirrhosis and refractory ascites (RA) treated with devices like Alfapump or tunneled-intraperitoneal catheters perform daily low-volume drainage without albumin substitution. Studies indicate marked differences regarding the daily drainage volume between patients; however, it is currently unknown if this alters the clinical course.ObjectiveTo determine whether the incidence of complications, such as hyponatremia or acute kidney injury (AKI), is associated with the daily drainage volume in patients with devices.Design, Setting, and ParticipantsThis retrospective cohort study of patients with liver cirrhosis, RA, and a contraindication for a transjugular intrahepatic portosystemic shunt who received either device implantation or standard of care (SOC; ie, repeated large-volume paracentesis with albumin infusion), and were hospitalized between 2012 and 2020 were included. Data were analyzed from April to October 2022.InterventionsDaily ascites volume removed.Main outcomes and MeasuresThe primary end points were 90-day incidence of hyponatremia and AKI. Propensity score matching was performed to match and compare patients with devices and higher or lower drainage volumes to those who received SOC.ResultsOverall, 250 patients with RA receiving either device implantation (179 [72%] patients; 125 [70%] male; 54 [30%] female; mean [SD] age, 59 [11] years) or SOC (71 [28%] patients; 41 [67%] male; 20 [33%] female; mean [SD] age, 54 [8]) were included in this study. A cutoff of 1.5 L/d or more was identified to estimate hyponatremia and AKI in the included patients with devices. Drainage of 1.5 L/d or more was associated with hyponatremia and AKI, even after adjusting for various confounders (hazard ratio [HR], 2.17 [95% CI, 1.24-3.78]; P = .006; HR, 1.43 [95% CI, 1.01-2.16]; P = .04, respectively). Moreover, patients with taps of 1.5 L/d or more and less than 1.5 L/d were matched with patients receiving SOC. Those with taps of 1.5 L/d or more had a higher risk of hyponatremia and AKI compared with those receiving SOC (HR, 1.67 [95% CI, 1.06-2.68]; P = .02 and HR, 1.51 [95% CI, 1.04-2.18]; P = .03), while patients with drainage of less than 1.5 L/d did not show an increased rate of complications compared with those receiving SOC.Conclusions and RelevanceIn this cohort study, clinical complications in patients with RA performing low-volume drainage without albumin infusion were associated with the daily volume drained. Based on this analysis, physicians should be cautious in patients performing drainage of 1.5 L/d or more without albumin infusion.

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“…Hyponatremia is another possible complication of prolonged MA drainage, however it may not have clinical signi cance, because it is often untreated or unrecognized. Nevertheless, a risk group of patients with hepatopancreatobiliary malignancy and hyponatremia before drainage was suggested for routine testing of plasma sodium concentration, because hyponatremia may have signi cant negative implications [22]. In another study sodium values declined both pre-and post-procedure (tunneled catheter insertion followed by drainage); the slope of decline diminished postprocedure compared with pre-procedure (sodium slope [-2.50 to 1.31 mEq/L, p = 0.037]).…”

Section: Safetymentioning

confidence: 99%

859 Symptomatic malignant ascites drainage with a patient-controlled vascular catheter – interim analysis of safety and patients’ reported outcomes

Stukan,

Jedryka,

Cokan

et al. 2024

Poster and E-Posters

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Malignant ascites (MA) and repeated paracentesis can impair patient's quality of life (QOL). The aim was to evaluate changes in patients' QOL and the safety of MA drainage with a patient-controlled central vascular catheter (CVC) inserted into the abdominal cavity. This is an interim analysis of a prospective, multicentre trial ongoing within the Central and Eastern European Gynaecologic Oncology Group (CEEGOG). CVC (14-Ga) was inserted into the abdominal cavity of patients with symptomatic MA and drainage was controlled by patients at home. The rate and quality of complications were classi ed according to Common Terminology Criteria for Adverse Events Version 5.0. QOL was evaluated before and 10-14 days after/during drainage with standardized QLQ-C15-PAL, SGA, and FACIT-TS-G questionnaires. Wilcoxon and Chi-squared tests were used. Among 113 recruited patients (2015-2022) 8 adverse events were detected in 7 patients (6.2%), including one serious (death on the 9th day after catheter insertion, classi ed as not related to the intervention). Other complications were local infection (n=2) (resolved after oral antibiotics), catheter obstruction (n=2), catheter self-removal (n=2) (re-insertion performed), and nausea (n=1). When comparing the assessment before and after/during drainage, we found the signi cantly better global quality of life (mean 31.8 vs 47.8, p<0.001), improvement in physical (52.6 vs 64.4, p<0.001) and emotional functioning (50.7 vs 65.4, p<0.001); symptoms were signi cantly less intense: fatigue (66.7 vs 50.9, p<0.001), nausea and vomiting (37.8 vs 21.4, p<0.001), pain (53.9 vs 34.1, p<0.001), dyspnoea (48.5 vs 22.3, p<0.001), insomnia (49.1 vs 34.3, p<0.001), appetite loss (56.3 vs 40.3, p<0.001), constipation (31.0 vs 25.2, p=0.007), and more patients had no pain on eating (71.3% vs 82.9%, p=0.04). Most patients (78%) were satis ed, 83% would recommend the procedure to others, and 90% would choose intervention again. MA drainage via patient-controlled CVC inserted into the abdominal cavity is safe and improves patients' QOL. from it in terms of better symptoms control, QOL, as well as part of the preparation to the treatment, not just for the end-stage[2], and not too late [3]. Patients presenting with MA require a comprehensive assessment and a management plan that addresses QOL [4]. There are many different approaches to managing MA, among which drainage is the most often applied and available. It can be performed with repeated paracentesis or via permanently inserted catheters of different types [1].This study aimed to perform a pre-planned interim analysis of an ongoing international trial on symptomatic malignant ascites drainage with a patient-controlled vascular catheter inserted into the abdominal cavity, in terms of safety, symptom control, and changes in patient's QOL. Materials and methodsThe international, multi-institutional trial entitled "Symptomatic malignant Ascites DRAinage with a PAtient-controlled vascular Catheter" (ADRAPAC) is prospectively conducted within the Central and E...

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Incidence of Hyponatremia in Patients With Indwelling Peritoneal Catheters for Drainage of Malignant Ascites

Cited by 7 publications

References 22 publications

Home‐based, tunnelled peritoneal drainage system as an alternative treatment option for patients with refractory ascites

Home‐based, tunnelled peritoneal drainage system as an alternative treatment option for patients with refractory ascites

Daily Low-Volume Paracentesis and Clinical Complications in Patients With Refractory Ascites

859 Symptomatic malignant ascites drainage with a patient-controlled vascular catheter – interim analysis of safety and patients’ reported outcomes

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