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Li F, Guan Y, Wang L, Zhou Z. Urgent-start peritoneal dialysis in the hemophilia a patient with chronic kidney disease: A case report. Clin Case Rep 2023; 11:e7659. [PMID: 37692151 PMCID: PMC10483496 DOI: 10.1002/ccr3.7659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 09/12/2023] Open
Abstract
Key Clinical Message This case illustrates that under comprehensive management of individual and clinical needs, urgent-start peritoneal dialysis can be performed safely without bleeding complications in patients with hemophilia A who developed end-stage renal disease. Patients in these cases can benefit from synthetic strategy. Abstract Hemophilia A is a serious inherited bleeding disorder resulting from a deficiency of coagulation factor VIII (FVIII). Chronic kidney disease (CKD) involvement in hemophilia is relatively rare, but there has been an upward trend in the survival time of patients with prolonged hemophilia. Although peritoneal dialysis (PD) is often used as the first treatment modality for renal replacement treatment, limited data are available on comprehensive management in the hemophilia A population, especially for urgent-start PD. A 56-year-old man who had hemophilia A, was diagnosed with CKD 3 years ago and developed end-stage renal disease was admitted to our hospital after contracting pneumonia and undergoing subsequent Type I respiratory failure. Urgent-start PD improved his condition and health outcomes, and protected his residual renal function. This case is the first study of a Chinese male patient with hemophilia A who developed end-stage renal disease. We summarize the clinical treatment and nursing care strategies of urgent-start PD in a hemophilia A patient with end-stage renal disease. This case illustrates that under comprehensive management of individual and clinical needs, urgent-start PD can be performed safely without bleeding complications in patients with hemophilia A.
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Affiliation(s)
- Fang‐Fang Li
- Department of EndocrinologyPeking Union Medical College HospitalBeijingChina
| | - Yu‐Xia Guan
- Department of NephrologyPeking Union Medical College HospitalBeijingChina
| | - Long‐Fei Wang
- Medicine DepartmentPeking Union Medical College HospitalPekingChina
| | - Zi‐Juan Zhou
- Department of NephrologyPeking Union Medical College HospitalBeijingChina
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Zheng H, Wang H, Zhou Z, Cai H, Liang J, Qin Y, Xia P, Chen L. End Stage Renal Failure Patients With Hemophilia Treated With Peritoneal Dialysis: A Case Series. Kidney Int Rep 2022; 7:2639-2646. [PMID: 36506225 PMCID: PMC9727524 DOI: 10.1016/j.ekir.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Currently, no consensus on optimal renal replacement modality has been reached for end-stage renal disease (ESRD) patients complicated with hemophilia. They may require infusion of coagulation factors during each hemodialysis session. In comparison, peritoneal dialysis (PD) might be preferred considering that coagulation replacement is only required for catheter placement. However, limited data on the safety and efficacy of PD for treating ESRD patients with hemophilia were reported. Methods This is a single-center retrospective cohort study. ESRD patients diagnosed with hemophilia under PD in Peking Union Medical College Hospital from January 1, 1996 to December 31, 2021 were included and followed-up with every month. Their baseline clinical data, catheter insertion procedure, coagulation factor replacement, complications, and outcome were analyzed and compared with general PD patients. Results In total, 8 patients diagnosed with hemophilia were included, all-male, with a mean age of 50.3±13.3 years old. Two were acquired hemophilia A, whereas the rest were hereditary hemophilia A (HHA). Seven patients experienced significant hemoglobin (Hgb) increment after PD. Peritoneal hemorrhage only consisted of a small portion of all hemorrhage. Patients with hemophilia seemed to have lower small solute clearance despite higher baseline peritoneal permeability, and appeared to have increased peritonitis rate than other male PD patients, yet this study is not powered to prove this. Conclusion PD is a safe and effective choice for patients with hemophilia and ESRD requiring dialysis. More studies are required to evaluate this certain rare group of patients.
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Affiliation(s)
- Hua Zheng
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Haiyun Wang
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
| | - Zijuan Zhou
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
| | - Huacong Cai
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Liang
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
| | - Yan Qin
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
| | - Peng Xia
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
| | - Limeng Chen
- Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases
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Induction of hemodialysis with an arteriovenous fistula in a patient with hemophilia A. CEN Case Rep 2020; 9:225-231. [PMID: 32180153 DOI: 10.1007/s13730-020-00461-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 02/27/2020] [Indexed: 10/24/2022] Open
Abstract
An 88-year-old man with congenital hemophilia A developed end-stage renal disease due to microscopic polyangiitis. He was at risk for catheter-related infection because he was taking immunosuppressive agents for the treatment of polyangiitis. He was also unable to manipulate the peritoneal dialysis device. Therefore, hemodialysis using an arteriovenous fistula was induced for renal replacement therapy. Recombinant coagulation factor VIII (1000 IU) was administered via the venous chamber of the hemodialysis circuit 10 min before the end of each hemodialysis session, and nafamostat mesylate (25 mg/h) was employed as an anticoagulant during hemodialysis. His clotting factor VIII activity level increased to > 50% and activated partial thromboplastin time decreased to 50 s at the end of each hemodialysis session. This method allowed him to achieve hemostasis at the puncture site of the arteriovenous fistula and undergo stable hemodialysis with no complications, including bleeding. This case suggests that hemodialysis using an arteriovenous fistula with coagulation factor replacement and nafamostat mesylate in each hemodialysis session is a therapeutic option for end-stage renal disease in patients of advanced age with hemophilia at high risk of bleeding.
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Wright E, Fischbach M, Zaloszyc A, Paglialonga F, Aufricht C, Dufek S, Bakkaloğlu S, Klaus G, Zurowska A, Ekim M, Ariceta G, Holtta T, Jankauskiene A, Schmitt CP, Stefanidis CJ, Walle JV, Vondrak K, Edefonti A, Shroff R. Hemodialysis in children with ventriculoperitoneal shunts: prevalence, management and outcomes. Pediatr Nephrol 2016; 31:137-43. [PMID: 26386590 DOI: 10.1007/s00467-015-3204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 08/13/2015] [Accepted: 08/28/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hemodialysis (HD) in children with a concomitant ventriculoperitoneal shunt (VPS) is rare. Registry data suggest that peritoneal dialysis with a VPS is safe, but little is known about HD in the presence of a VPS. METHODS We performed a 10-year survey to determine the prevalence of a VPS, complications and outcome in children with a VPS on HD in 15 dialysis units from the 13 countries participating in the European Pediatric Dialysis Working Group. RESULTS Eleven cases of HD with a VPS were reported (prevalence 1.33 %; 328 patient-months) and compared with prospective Registry data. The median age at start of dialysis was 9.6 [inter-quartile range (IQR) 1.0-15.0] years and median HD vintage was 2.4 (IQR 1.7-3.0) years. Dialysis was performed through a central venous line (CVL) and through an arteriovenous fistula in six and five children, respectively. Three CVL infections occurred in two children, but these children did not develop VPS infections or meningitis. Symptoms of hemodynamic instability were reported in six (55 %) children at least once per week, with hypotension or hypertension occurring in four of these children and nausea, vomiting and headaches occurring in two; four other children reported less frequent symptoms. Seizures on dialysis occurred in two children, at a frequency of less than once per month, with one child also experiencing visual disturbances. During follow-up (median 4.0; IQR 0.38-7.63 years), three children remained on HD and eight had a functioning transplant. No patients were switched to PD. CONCLUSIONS Hemodialysis in children with a VPS is safe, but associated with frequent symptoms of hemodynamic instability. No episodes of VPS infection or meningitis were seen among the children in the survey, not even in those with CVL sepsis.
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Affiliation(s)
- Elizabeth Wright
- Nephro-Urology Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
| | | | | | - Fabio Paglialonga
- Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Stephanie Dufek
- Nephro-Urology Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
| | | | | | | | | | - Gema Ariceta
- University Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | | | - Alberto Edefonti
- Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Rukshana Shroff
- Nephro-Urology Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK.
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Esposito P, Rampino T, Gregorini M, Fasoli G, Gamba G, Dal Canton A. Renal diseases in haemophilic patients: pathogenesis and clinical management. Eur J Haematol 2013; 91:287-94. [PMID: 23651176 DOI: 10.1111/ejh.12134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2013] [Indexed: 02/05/2023]
Abstract
Haemophilia A and B are genetic X-linked bleeding disorders, caused by mutations in genes encoding factors VIII and IX, respectively. Clinical manifestations of haemophilia are spontaneous haemorrhage or acute bleeding caused by minor trauma, resulting in severe functional consequences that can culminate in a debilitating arthropathy. Life expectancy and quality of life of patients with haemophilia have dramatically improved over the last years, mainly for new therapeutic options and the awareness to the risk of HCV and HIV infections. Different clinical problems arise from this important change in history of patients with haemophilia. In particular, ageing-related diseases, such as diabetes, hypertension and cancer, and chronic viral infections are emerging as new challenges in this patient population. Among the different types of chronic illnesses, renal diseases are of special interest as they involve some difficult management issues. In fact, decisions regarding adequate preventive strategies and viral infection treatment, the choice of the dialytic modality, placement of vascular access and prescription of dialytic treatments are particularly complicated, because only few data are available. In this review, we discuss the pathogenesis of renal damage in patients with haemophilia, especially in those with blood-transmitted viral infections, and the major issues about the management of renal diseases, including problems related to dialytic treatment and kidney transplantation, providing practical algorithms to guide the clinical decision-making process.
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Affiliation(s)
- Pasquale Esposito
- Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico S.Matteo and University of Pavia, Pavia, Italy
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