Unexpected Nonocclusive Mesenteric Infarction during Continuous Ambulatory Peritoneal Dialysis

Appel, Richard G.

doi:10.1159/000168723

Cited by 9 publications

(6 citation statements)

References 10 publications

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“…In recent years, non-occlusive mesenteric ischemia (NOMI) has become increasingly recognized as a highly dangerous complication in both hemodialysis [1,2,3,4,5,6,7,8,9,10,11,12] and peritoneal dialysis patients, young and old alike [13,14,15]. Undoubtedly, NOMI is seen far more often in hemodialysis patients, with intradialytic hypotension being the major precipitating factor behind the development of NOMI among these patients [1, 2,4,5,6, 11].…”

Section: Introductionmentioning

confidence: 99%

Non-Occlusive Mesenteric Ischemia in Chronically Dialyzed Patients: A Disease with Multiple Risk Factors

et al. 2005

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Background: Non-occlusive mesenteric ischemia (NOMI) can be a fatal complication in dialysis patients. Intradialytic hypotension is usually the precipitating factor. The occurrence of 16 cases in 5 years (1998–2002), compared with only 4 in previous years, led us to investigate other risk factors contributing to NOMI. A control group of stable hemodialysis patients was used for comparison. Results: 20 patients were studied: 17 diagnosed surgically, and 3 clinically. The mean age was 70.8 ± 1.8 years, and the male:female ratio 7:13. Nineteen patients were on hemodialysis. Clinically overt atherosclerosis was present in 17 patients. Preceding dialysis-associated hypotension was identified in all patients studied and access thrombosis in 6 patients. In all patients, abdominal pain was the presenting symptom. Initial abdominal examination was unimpressive in 16 patients. The hemoconcentration, leukocytosis and metabolic acidosis were the most prominent laboratory findings. 5/11 abdominal sonograms showed intestinal pathology. 2/3 angiographies were diagnostic. Three patients responded to early fluid challenge and did not require surgery. Pathology was related to the area of the superior mesenteric artery in all 15 patients operated. Twelve (60%) patients died from the event. The 1-year mortality rate was 17/20 patients (85%). Possible contributing factors, other than dialysis-associated hypotension, included: high-dose recombinant human erythropoietin (rhEPO) therapy (179 ± 35 vs. 116 ± 10 U/kg/week in the control group, p < 0.05); metastatic calcifications (abdominal aorta 14/14, aortic valve 11/18; medial calcification of mesenteric arteries in 2/11 pathology specimens); digoxin, and hypoalbuminemia. Conclusions: The increased incidence of NOMI in dialysis patients may be related to overly aggressive rhEPO therapy and the unsuspected presence of mesenteric arterial medial calcifications. Identification of patients at risk, prevention of intradialytic hypotension and a controlled increase in dry weight may help to reduce the incidence of NOMI in chronically dialyzed patients.

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Section: Introductionmentioning

confidence: 99%

Non-Occlusive Mesenteric Ischemia in Chronically Dialyzed Patients: A Disease with Multiple Risk Factors

et al. 2005

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“…[ 2 ] Besides the traditional risk factors, CKD patients are more prone for vascular calcification[ 3 ] and increasing risk of ischemia because of the use of erythropoietin. [ 4 5 ] Erythropoietin has also direct vasopressor effect on mesenteric blood vessels. [ 6 ]…”

Section: Discussionmentioning

confidence: 99%

Mesenteric ischemia masquerading as refractory peritonitis in continuous ambulatory peritoneal dialysis patients

Vishwakarma¹,

Anandh

2015

Indian J Nephrol

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We report two cases of mesenteric ischemia in patients on long term peritoneal dialysis both of which were associated with poor outcomes. Both were diabetic and on peritoneal dialysis for a long time. On evaluation of refractory peritonitis we found evidence of non occlusive mesenteric ischemia. Despite adequate treatment both succumbed to their illness. Abdominal pathology, especially mesenteric ischemia leading to gut infarction, should be considered in patients with refractory peritonitis.

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“…This increased hematocrit leads to hyperviscosity and consequently a low flow state. The mechanism just described can be reproduced through the use of recombinant human erythropoietin (rHuEPO) (23,24). Studies in an in vitro and ex vivo model demonstrated that EPO also has a direct vasopressor effect on small mesenteric resistance vessels (25).…”

Section: Discussionmentioning

confidence: 99%

Nonocclusive Mesenteric Ischemia: A Lethal Complication in Peritoneal Dialysis Patients

et al. 2007

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Nonocclusive mesenteric ischemia (NOMI) is a relatively uncommon disorder, seen primarily in elderly patients with cardiac disease, and is characterized by progressive intestinal ischemia leading to infarction, sepsis, and death. It is suspected of being the underlying cause in at least 20% – 30% of acute mesenteric ischemia patients. End-stage renal disease patients are among the highest risk populations for developing this lethal complication; however, NOMI is not unique to hemodialysis and can occur in peritoneal dialysis patients as well. Unfortunately, the presentation of NOMI is very similar to that of peritonitis. The key to correct diagnosis is a high index of suspicion in predisposed patients. The high mortality rate is a clear reflection of failure to recognize the syndrome at an earlier, treatable stage. We present our case experience and an extensive review of the literature regarding this dreadful complication that may be reversible if considered early as a possible etiology and the appropriate diagnostic maneuvers undertaken.

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Unexpected Nonocclusive Mesenteric Infarction during Continuous Ambulatory Peritoneal Dialysis

Cited by 9 publications

References 10 publications

Non-Occlusive Mesenteric Ischemia in Chronically Dialyzed Patients: A Disease with Multiple Risk Factors

Non-Occlusive Mesenteric Ischemia in Chronically Dialyzed Patients: A Disease with Multiple Risk Factors

Mesenteric ischemia masquerading as refractory peritonitis in continuous ambulatory peritoneal dialysis patients

Nonocclusive Mesenteric Ischemia: A Lethal Complication in Peritoneal Dialysis Patients

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