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Fukumi A, Tanaka M, Sugae A, Ishida Y, Yamamoto H, Watanabe T, Fukushima C, Miyauchi M, Teragaki M, Maeda K, Takami Y, Iwanari S, Ikeda M, Takeoka H. Hypereosinophilia-associated acute intradialytic hypotension: a report of three cases and literature review. CEN Case Rep 2024:10.1007/s13730-024-00850-w. [PMID: 38277067 DOI: 10.1007/s13730-024-00850-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/31/2023] [Indexed: 01/27/2024] Open
Abstract
Occasionally, patients undergoing dialysis develop acute severe hypotension that requires interruption of dialysis within minutes of initiating every dialysis session. Although the underlying causes of recurrent intradialytic hypotension are evaluated extensively, including dialysis-associated allergic reactions or other possible causes, the definitive cause is sometimes missed. Dialysis is a life-sustaining procedure; therefore, prompt identification and management of the underlying cause of dialysis intolerance are crucial. Herein, we report three cases of patients undergoing dialysis who presented with hypereosinophilia-associated acute intradialytic hypotension. All three patients developed acute severe hypotension within minutes after the start of every dialysis session. The prescriptions for dialysis were changed, but episodes of intradialytic hypotension persisted. Pretreatment with methylprednisolone given intravenously before the dialysis session was also ineffective. All patients had hypereosinophilia (> 1500/μL) of different etiology. Eosinophil-lowering therapy with 0.5 mg/kg of prednisolone given orally daily was initiated, and all of them could restart dialysis without any hypotensive episodes within a few days. Our case report and literature review indicated that hypereosinophilia, regardless of its etiology, could result in severe acute hypotension shortly after the start of dialysis session. The oral administration of prednisolone daily was highly effective on hypereosinophilia-associated intradialytic hypotension, while pretreatment with intravenous corticosteroid therapy just before dialysis had no effect. Hypereosinophilia-associated acute intradialytic hypotension is an under-recognized condition; therefore, clinicians need to be aware of this clinical entity and initiate effective treatment strategies. We also provide a brief summary of previously published cases.
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Affiliation(s)
- Awaisshafiq Fukumi
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan.
| | - Mari Tanaka
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Akane Sugae
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Yuki Ishida
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Hiroko Yamamoto
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Tomoka Watanabe
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Chiho Fukushima
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Miho Miyauchi
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Mariko Teragaki
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Kotaro Maeda
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Yohtaro Takami
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Sachio Iwanari
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Masaki Ikeda
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Hiroya Takeoka
- Department of Nephrology and Dialysis, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
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