The incidence and prevalence of chronic kidney disease (CKD) has increased worldwide and in Indonesia. There were about 53,940 people with stage 5 CKD based on data from the Indonesian Renal Registry (IRR) in 2018. Incidence crude rate is 251 per million population and prevalence crude rate is 499 per million population for the entire population1. The prevalence of CKD has almost doubled in 5 years, from 2‰ in 2013 to 3.8‰ in 2018. Hemodialysis (HD) is a renal replacement therapy modality that is in great demand by the public compared to the other two modalities, namely peritoneal dialysis and kidney grafts. In 2018, there was a consistent increase in the number of new patients and active HD patients. Active patients is the total number of patients (either new or old patients) who are still undergoing routine HD. The number of new patients has doubled compared to 2017. This also resulted in a sharp increase in the number of active patients compared to the previous year.

Introduction Central venous catheter (CVC) insertion is the most commonly performed clinical procedure when a patient initiates hemodialysis. Despite its clinical benefits, CVC insertion has several risks of complications. Thrombosis, venous stenosis, infection, arrhythmia, pneumothorax, and bleeding are among these complications. Malposition of the tip of the CVC can also occur with an incidence of up to 7%. One of several factors that could contribute to malposition is venous anatomy variation. Persistent left superior vena cava (PLSVC) is an extremely rare venous anatomical disorder but might have a significant clinical impact. Case Presentation Here we report a PLSVC case that was identified in chest radiography after the insertion of a CVC catheter in a patient with end-stage renal disease (ESRD). A 40-year-old woman with a history of type 2 diabetes mellitus, hypertension, dyslipidemia, and obesity was presented in the emergency room with dyspnea for 1 week. Acute hemodialysis was required because of the ESRD and pulmonary edema. The PLSVC condition accompanied by various complications that occurred in this patient became a dilemma for the nephrologist in determining the diagnosis and proper CVC management. Discussion PLSVC is the most common congenital abnormality of the vena cava, even though it has a very small incidence. PLSVC occurs in about 0.1–0.5% of the total population and reaches 10% in individuals with congenital heart abnormalities. Most PLSVC presents along with normal superior vena cava and drains into the right atrium, which makes it very difficult to see the clinical signs and symptoms. Almost all PLSVC conditions are found incidentally during or after invasive procedures such as CVC insertion. CVC insertion in the PLSVC condition needs proper management to minimize the risk of complications. Conclusion This case shows the importance of understanding the PLSVC condition, which, although very rare, is expected to increase the awareness of the nephrologist in making the diagnosis, determining appropriate management, and preventing complications, thereby improving patient safety.

No abstract

No abstract