Erythrocytosis is associated with intradialytic hypotension: a case series

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.

Low-Dose Dopamine in the Management of Intradialysis Hypotension: A Retrospective Cohort Study in Nigeria

“…55 Similarly, higher viscosity from frequent erythropoietin use would be more likely to induce sluggish flow, dialyser blood clotting, and elevated blood pressure, and at times dialysis termination. 56 Agarwal et al 57 in their findings noted an positive relationship between the hematocrit and the risk of IDH.…”

Construction and Application of Machine Learning Models for Predicting Intradialytic Hypotension

“…A total of 44 clinical features were collected for this study, encompassing demographic characteristics (gender, age, dialysis age (DA), height, and weight), primary diseases (hypertensive nephrosclerosis (HN), diabetic nephropathy (DN), gouty nephropathy (GN), chronic glomerulonephritis (CGN), among others), comorbidities (hypertension (HTN), diabetes mellitus (DM), gout), vital signs (systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) [18]), laboratory tests (white blood cell count (WBC) [19], hemoglobin (Hb) [20], hematocrit (Hct), platelet count (Plt), potassium (K), sodium (Na) [21], phosphorus (P) [22], calcium (Ca), albumin (Alb) [23], parathyroid hormone (PTH) [24]), ultrasound and imaging examinations (cardiothoracic ratio (CTR), left ventricular mass index (LVMI), ejection fraction (EF)), hemodialysis access (autologous arteriovenous stula (AVF), grafted vascular stula (GVF), long-term tunneled hemodialysis catheter (LTHC), temporary hemodialysis catheter (THC)), dialysis settings (dialysis frequency (DF), dialysis duration (DD), dry weight (DW), interdialytic weight gain rate (IDWGR), ultra ltration volume (UFV), ultra ltration rate (UFR)), and dialysis adequacy indexes (urea clearance index (Kt/V), urea reduction ratio (URR)). The speci c formulas for these calculations are provided below.…”