Challenges of Caring for an Advanced Chronic Kidney Disease Patient with Severe Thrombocytopenia

Abstract

An autogenous arteriovenous fistula has been considered to be the optimal form of vascular access for hemodialysis (HD) in the field of nephrology. Nevertheless, the decision regarding the type of access, whether it be an arteriovenous fistula, an arteriovenous graft, or a central venous catheter, must still be individualized. In the present report, we describe the case of a female patient with advanced chronic kidney disease (CKD) associated with a hemostatic disorder. Despite the exhausted peripheral vasculature, she required recurrent platelet transfusions for severe thrombocytopenia due to aplastic anemia. The goal of care for this patient was to optimize the dialysis treatment without increasing the bleeding risk. Various concerns regarding the therapeutic conundrums encountered in the case are also discussed.

Successful Introduction of Peritoneal Dialysis in an End-stage Renal Failure Patient with Idiopathic Aplastic Anemia

“…In our patient, hemosiderosis due to frequent blood transfusions and adverse drug effects was expected (1). To date, there have been only a few reports of AA patients, including those with secondary AA, who developed ESRD that was managed by maintenance HD (4,5,14). Their prognoses were reportedly poor, with most patients dying within approximately half a year due to infection and/or bleeding.…”

“…Thus far, there have been only a few case reports of maintenance hemodialysis (HD) in patients with AA (4)(5)(6). The prognoses of these cases were poor because of the potential for the development of uncontrolled bleeding, manifesting as cerebral hemorrhaging and gastrointestinal bleed-ing, and/or sepsis, including pneumonia and infection related to the arteriovenous fistula (AVF) used as the vascular access site.…”

Hemolytic Uremic Syndrome: An Increasingly Recognized Public Health Problem

“…18 The severe thrombocytopenia in our patient at transfer obliged us to follow the current recommendations regarding the platelet threshold of >5 × 10 4 /μL during the periprocedural period for various invasive interventions, such as lumbar puncture, laparotomy, and the insertion of indwelling lines. 19,20 The validity of employing such a periprocedural management policy in all patients with HUS with severe thrombocytopenia should be assessed comprehensively, as an uneventful central venous catheter placement may not be uncommon among patients with TTP/HUS with platelet counts of <2 × 10 4 /μL. 21 However, we believe that it is necessary to take a proactive approach before serious hemorrhagic events become apparent.…”

Intravenous Methylprednisolone Pulse Therapy in Paediatric Patients With Typical Haemolytic Uremic Syndrome and Neurological Complications

“…More recent studies (cohorts after 2010), have better outcomes with lower mortality,13.9% (IQR:12.5 -22%)] [34]. Over the past two decades, high-dose intravenous mPSL pulse therapy (an approach already used to treat several neurological syndromes) has been used in various studies in the field of HUS to avoid the development of side effects and maintain long-term efficacy [22,[35][36][37][38]43]. In a previous study, a 14-year-old girl was successfully treated of STEC-HUS and acute encephalopathy with high-dose steroid pulse therapy (two courses of IV methylprednisolone 500 mg/day for 3 days) in association with plasma exchange, obtaining full recovery [37].…”