The Phantom of the Peritoneum
- Home Dialysis - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
- El Mouhayyar, Christopher, Massachusetts General Hospital, Boston, Massachusetts, United States
- Cheung, Pui Susan Wen, Massachusetts General Hospital, Boston, Massachusetts, United States
Patients in urgent need of dialysis are commonly started on hemodialysis (HD) via a central venous catheter. More recently, acute to urgent start peritoneal dialysis (PD) is becoming an alternative. Studies have shown that the incidence of acute and chronic pancreatitis in PD patients was higher compared to HD patients and the general population. Most studies looked at patients on chronic PD. Here, we present a case of urgent start PD complicated by acute pancreatitis.
A 58-year-old woman with a past medical history pertinent for ischemic stroke and CKD stage V with loss to follow up for months, and a one-week-old PD catheter presented to the emergency department with tonic-clonic seizures. She was given lorazepam with no response, so she was transferred to a tertiary care hospital. Labs showed a BUN of 117 mg/dL, similar to her BUN for the past month (94-112mg/dL), Cr 15.2 mg/dL, eGFR of 2 mL/min/1.73 m2, potassium of 5.5, lactic acid of 0.6 mmol/L, bicarbonate 15 mg/dL, creatinine kinase 347. CT head was unremarkable. EEG showed no evidence of seizure activity. She was started on PD with low volume runs of 500ml, which she tolerated and gradually increased to 1L. She was eventually extubated successfully. However, while into her fourth run, she started complaining of severe abdominal pain, nausea and vomiting. The PD was stopped. Lipase level came back elevated at 3000. CT abdomen pelvis showed pancreatic and peripancreatic edema with surrounding fluid consistent with acute pancreatitis. PD was held, and the patient was switched to HD. She improved and was discharged home with an outpatient dialysis unit. Her seizure was thought to be due to her old stroke per neurology. She was transitioned back to PD 8 weeks later and has tolerated it well.
The majority of ESKD patients are started on in-center HD via a central venous catheter. The use of PD has been increasing in the last decade. Unplanned hemodialysis via a CVC is associated with higher rates of infection and reduced rates of survival compared to PD. Ideally, all patients with CKD should start dialysis in a planned elective manner rather than urgently. The evidence with regard to pancreatitis while on PD is controversial. Some studies report a higher incidence, while others do not. This case is the first to report acute pancreatitis in an urgent start of PD.