1
|
Agrawal S, Ramachandran P, Gill R, Spitalewitz S, Gunzler D, Silver MR, Horwitz EJ, Schelling JR. Erythrocytosis is associated with intradialytic hypotension: a case series. BMC Nephrol 2019; 20:235. [PMID: 31266452 PMCID: PMC6604273 DOI: 10.1186/s12882-019-1426-7] [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: 04/26/2018] [Accepted: 06/21/2019] [Indexed: 11/25/2022] Open
Abstract
Background For patients with end stage renal disease undergoing hemodialysis, erythrocytosis occurs rarely. Erythrocytosis increases the risk of thrombosis, which is a common complication in hemodialysis patients. The risk of thrombosis may also be increased by hypotension. The purpose of our report is to examine the relationship between intradialytic hypotension and erythrocytosis. Case presentation We present a series of five patients with end stage renal disease and erythrocytosis (peak hemoglobin range 15.2–18.5 g/dL). All were erythropoiesis-stimulating agent naïve and non-smokers. Prior to developing erythrocytosis, each patient developed recurring episodes of intradialytic hypotension over several months. A statistically significant inverse correlation was observed between nadir intradialytic systolic blood pressure and hemoglobin concentration. In the index case, midodrine treatment resulted in resolution of the hypotension and erythrocytosis. Most of the patients had multiple acquired renal cysts, which is a potential source of erythropoietin. Four of the five cases developed arteriovenous dialysis access or deep venous thrombosis. Conclusions An association between intradialytic hypotension and erythrocytosis was observed in five cases. We postulate that chronic intermittent hypotension and renal ischemia may lead to erythropoietin secretion, and this cascade could represent a newly recognized cause of secondary erythrocytosis.
Collapse
Affiliation(s)
- Shree Agrawal
- Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH, 44016, USA
| | - Preethi Ramachandran
- Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH, 44016, USA.,Department of Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | - Rupinder Gill
- Brookdale University Hospital Medical Center, Brooklyn, NY, 11212, USA
| | | | - Douglas Gunzler
- MetroHealth Medical Center Center for Health Care Research and Policy, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | - Marcia R Silver
- Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH, 44016, USA.,Department of Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | - Edward J Horwitz
- Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH, 44016, USA.,Department of Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | - Jeffrey R Schelling
- Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH, 44016, USA. .,Department of Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA.
| |
Collapse
|
2
|
Idiopathic erythrocytosis in a patient on chronic hemodialysis. Kidney Res Clin Pract 2015; 34:60-3. [PMID: 26484022 PMCID: PMC4570647 DOI: 10.1016/j.krcp.2014.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/12/2014] [Accepted: 09/17/2014] [Indexed: 11/30/2022] Open
Abstract
A 78-year-old man on hemodialysis presented to our hospital with erythrocytosis. He had started hemodialysis 4 years previously, with a hemoglobin level of 9.8 g/dL, and was administered erythropoiesis stimulating agents and ferrous sulfate. Two years previously, his hemoglobin level increased to 14.5 g/dL and the treatment for anemia was discontinued. He continued hemodialysis thrice weekly; however, the hemoglobin level had increased to 17.0 g/dL at the time of presenting to our hospital. His serum erythropoietin level was 31.4 mIU/mL (range, 3.7–31.5 mIU/mL), carboxyhemoglobin level was 0.6% (range, 0–1.5%), and oxygen saturation in ambient air was 95.4%. The JAK2 V617F mutation was not observed and other bone marrow abnormalities were not identified. The patient was diagnosed with bladder cancer and a transurethral resection was performed. Eight months after the treatment of bladder cancer, his hemoglobin level was 15.1 g/dL, and he was diagnosed with idiopathic erythrocytosis.
Collapse
|