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Abstract: PO1311

Peritoneal Dialysis in the Setting of Acute Brain Injury, an Underappreciated Modality

Session Information

Category: Trainee Case Report

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Wang, Elaina J., Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
  • Shah, Ankur, Division of Nephrology, Rhode Island Hospital, Providence, Rhode Island, United States
Introduction

Dialysis is complicated in the setting of acute brain injury due to a number of factors including acute shifts of solute, acute acid base shifts, need for anticoagulation, and changes in intracranial pressure. For these reasons, CRRT is the modality of choice when renal replacement therapy is needed. PD is less discussed but shares many of the benefits often attributed to CRRT. We describe a case successfully managed with PD.

Case Description

A 25-year-old male with history of ESRD secondary to FSGS on CCPD for 5 years presented to the hospital with headache and altered mental status. He was in his usual state of health until the day prior to admission. Initial imaging revealed a large intraventricular hemorrhage extending to the 4th ventricle. He underwent an emergent right depressive hemicraniectomy and clot evacuation. Patient was admitted to NCCU. Post-operative imaging revealed worsening cerebral edema, intraventricular hemorrhage, and hydrocephalus. As the patient had a functioning tenkhoff catheter, the decision was made to continue peritoneal dialysis, which he tolerated well until the need for a percutaneous gastrostomy tube arose. He was transitioned to hemodialysis transiently but returned to peritoneal dialysis once he was able to tolerate oral food. He has now continued on PD for 1 year.

Discussion

In the dialytic management of patients with acute brain injury, a number of considerations must be undertaken including the avoidance of hypotension to minimize ischemia reperfusion injury and maintain cerebral perfusion pressure, avoidance of anticoagulants that can precipitate or worsen bleeding, the potential for the precipitation of cerebral edema by rapid solute clearance and osmotic dissipation of therapeutic hypernatremia, and the mitigation of intracellular acidosis from bicarbonate delivery. Peritoneal dialysis is an ideal but underreported modality as evidenced by the case presented.