Anorexia nervosa and dialysis: we have no time when the body is so damaged!

Abstract

Anorexia nervosa remains challenging to treat and difficult to prevent. Nearly 5% of affected individuals die of this disease and 20% develop a chronic eating disorder. Anorexia nervosa may be associated with several medical complications of varying severity, including dysfunction of the renal system. Though there are some reports of renal failure in patients with anorexia nervosa, few reports are available concerning patients who required maintenance dialysis. We report a case of a patient with long-term untreated anorexia nervosa-binge eating/purging type who started psychiatric treatment when in a life-threatening situation (renal failure requiring dialysis), with unsuccessful weight recovery while on dialysis and died of septicaemia. The mechanisms that seem to be involved in the development of end-stage renal disease in this patient and the challenges associated with her treatment are reviewed. Patients with anorexia nervosa should be carefully monitored to discover the subtle manifestations of early renal failure.

Risk of dialysis and renal diseases in patients with anorexia nervosa in Taiwan

“…Although both the AN and control groups had low rates of acute dialysis, a significantly higher risk of acute dialysis remained among patients with AN relative to controls. Patients with AN and hypokalemia, which is easily detect- failure (e.g., due to rhabdomyolysis or electrolyte disturbances) requiring acute dialysis was reported in patients with AN with pre-existent renal dysfunction due to chronic volume depletion, malnutrition, hypokalemia, and laxative abuse (Abe et al, 1990;Os orio et al, 2013;Wada et al, 1992). Patients with AN may die from medical complications before progressing to ESRD (Os orio et al, 2013), a hypothesis that might explain our finding that patients with AN did not have a significantly higher risk of ESRD compared with the controls.…”

Renal and electrolyte complications in eating disorders: a comprehensive review

“…Dialysis has significant effects on quality of life, and patients on dialysis have lower life expectancy, primarily due to increased risk of cardiovascular disease and infection [ 14 ]. The rate of dialysis in patients with AN is unknown, though there are case series and case reports of patients with AN who developed ESRD and underwent dialysis, including one patient with longstanding AN-BP who began peritoneal dialysis with subsequent death from sepsis [ 15 , 16 ].…”

“…However, mechanisms of kidney disease vary significantly based on subtype of ED and behaviors involved. Risk factors for kidney disease include nutritional status, duration of disease, chronic dehydration caused by decreased oral intake and/or purging behaviors, nephrocalcinosis (calcium deposits in the kidneys), body mass index (BMI), bradycardia, and hypokalemia [ 8 , 15 , 18 ].…”

“…In patients with AN-R and kidney disease not attributed to the effects of covert purging and hypokalemia, hypovolemia (decreased intravascular volume) from chronic dehydration as a result of decreased oral intake combined with bradycardia may lead to decreased renal perfusion and impairment [ 8 , 15 , 18 ]. This is plausible given bradycardia is a very common complication of malnutrition [ 9 ].…”

Prevention of end‐stage renal disease with percutaneous endoscopic gastrojejunostomy tubes in a patient with recurrent episodes of binge eating and purging

“…For example, self‐induced vomiting and laxative abuse can cause hypokalemia, which results in prolonged QTc interval, leading to severe ventricular tachycardia, known as torsades de pointes 1 . A previous report described the mechanisms of progressing end‐stage renal disease (ESRD) in a chronic BN patient who finally died of septicemia 2 . In terms of prognosis, a 10‐year follow‐up study showed that 52% of BN patients made a full recovery and the full symptoms of BN continued in 9% of the patients 3 .…”