# Etiology and Outcomes in Patients With Chronic Kidney Disease and Ascites

## TL;DR

This study examines the causes and outcomes of ascites in patients with chronic kidney disease, finding that most cases have an identifiable cause and a poor prognosis.

## Contribution

The study provides new insights into the etiology and mortality rates of nephrogenic ascites in CKD patients.

## Key findings

- Nephrogenic ascites was identified in 27.5% of CKD patients with ascites.
- Most patients with ascites had an identifiable cause, such as cardiac or liver disease.
- The 90-day mortality rate among patients with ascites was high, with 13 out of 27 patients dying.

## Abstract

Introduction

Nephrogenic ascites is an uncommon disorder associated with grave prognosis. Studies on etiopathogenesis and outcomes are scarce. This study aimed to identify the etiologies of ascites in patients with chronic kidney disease (CKD) and estimate the proportion of nephrogenic ascites and the 90-day mortality.

Methods

This was a prospective, observational, and 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

A total of 355 patients were recruited, with 72.5% being males. Of these, 76 were newly diagnosed with CKD. The most common comorbidities were diabetes mellitus and hypertension. Forty patients had ascites with a mean duration of CKD and hemodialysis of 20.9±23.1 months and 9.3±15.5 months, respectively. Thirteen of the 40 patients with ascites were lost to follow-up. Among the remaining 27, 13 died during follow-up. A known etiology was seen in 29 of the 40 (72.5%) patients. The multiple etiologies group (any combination of cardiac or liver disease, malignancy, and hypothyroidism) constituted 21 patients. Overall, among the 40 patients with ascites, 11 (27.5%) had nephrogenic ascites of whom, four died during follow-up.

Conclusions

Nephrogenic ascites was observed in 11 patients. Most patients with ascites in CKD have an identifiable etiology. The prognosis of ascites in patients with CKD in our study was dismal.