Etiology and outcomes in patients with chronic kidney disease and ascites.

Abstract Purpose Nephrogenic ascites is an uncommon disorder associated with a grave prognosis. Literature on etiopathogenesis and outcomes are scarce. The objectives were to identify the etiologies of ascites in patients with chronic kidney disease (CKD) and estimate the proportion of nephrogenic ascites and their 90-day mortality. Methods It was a prospective observational hospital-based study. Consecutive patients with CKD admitted to a tertiary care government teaching hospital were recruited. History, examination, investigations, and evaluation of the etiology of ascites were performed. Ascites was classified into high and low serum albumin-ascites gradient types. Patients with ascites were also followed up for three months to monitor for worsening symptoms, further workup (if necessary), and mortality. Results 355 patients were recruited with 72.5% males. 76 were newly diagnosed with CKD. The most common comorbid illnesses were diabetes mellitus and hypertension. 40 patients had ascites with a mean duration of CKD and hemodialysis of 20.9 ± 23.1 and 9.3 ± 15.5, respectively. 13/40 were lost to follow-up. 13 of the remaining 27 who were followed up died. A known etiology was seen in 29/40 (72.5%). The mixed group (any combination of cardiac or liver disease, malignancy, and hypothyroidism) constituted 21/40 patients. 11/40 (27.5%) probably had nephrogenic ascites and 4/11 died during follow-up. Conclusions A tenth of patients with CKD have ascites. A majority of patients with ascites in CKD have an identifiable etiology. The prognosis of ascites in patients with CKD is dismal.