Questions About PD
I was unable to find any published reports on the use of PD in patients with malignant ascites. With respect to cirrhosis related ascites, there is some literature (case reports and retrospective analyses) and some advocate PD as a better option than HD in this situation. Malignant ascites is clearly a different entity and it may not be appropriate to extrapolate cirrhosis related ascites data to this population. There are some case reports of using PD catheters in the management of malignant ascites, but not in ESRD patients.
One of the largest case reports is by Lungren et al. who reported on the use of PD catheters in the management of refractory ascites via radiologically placed PD catheters (Lungren et al., JVIR, 2013). As above, these are not ESRD patients, and the PD catheters are solely for ascites management, not dialysis. Out of 193 catheters placed, 170 were placed for malignant etiologies. Their mean catheter survival rate was 60 days. Out of a total of almost 12,000 catheter-days, they noted five episodes of catheter malfunction, four leaks, three episodes of cellulitis and two episodes of peritonitis. The complication rate was 0.43 events/ year.
So, while use of peritoneal catheters to treat malignant ascites has been done with an acceptable complication rate, it is not clear whether these rates would hold were one to add a peritoneal dialysis prescription in an ESRD patient. Although not backed by data my own opinion is that this is not an absolute contraindication for peritoneal dialysis.