Recurrent Hepatic Coma in a Chronic Hemooialysis Patient: Successful Treatment by CAPO

Abstract

A hemodialysis patient developed hepatic cirrhosis with subsequent portal-systemic encephalopathy. Switching from hemodialysis to CAPD prevented the recurrent episodes of hepatic coma. This observation suggests that, in combined chronic renal and hepatic failure with portal-systemic encephalo pathy, CAPD may be the treatment of choice. This paper presents evidence to support this assumption.

Chronic hemodialysis patients frequently develop hepatitis B, which sometimes results in hepatic cirrhosis. Portal-systemic encephalopathy (PSE) may ensue. We describe a patient in whom mild PSE repeatedly progressed to full hepatic coma during hemodialysis sessions. Switching the patient from hemodialysis (HD) to continuous ambulatory peritoneal dialysis (CAPD) prevented the recurrent hepatic coma.