Abstract: TH-PO0851
Thalidomide as Salvage Therapy for Refractory Gastrointestinal Angiodysplasia-Induced Bleeding in ESKD
Session Information
- Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
- 1900 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
Authors
- Ishag, Mohammedelnour, Manchester University NHS Foundation Trust, Manchester, England, United Kingdom
- Jayanti, Anuradha, Manchester University NHS Foundation Trust, Manchester, England, United Kingdom
Introduction
Gastrointestinal angiodysplasia is a recognised cause of recurrent bleeding in advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Management is challenging when lesions are multiple, diffuse, or inaccessible, and evidence for thalidomide use in predialysis CKD or haemodialysis remains limited. We report two cases of transfusion-dependent gastrointestinal bleeding due to angiodysplasia in patients with advanced kidney disease.
Case Description
Case 1 was a 78-year-old woman with CKD stage V managed with supportive kidney care. She developed recurrent melaena secondary to multiple gastric and duodenal angiodysplasias. Bleeding persisted despite argon plasma coagulation. Thalidomide was commenced as a planned 4-month course, starting at 50 mg daily for 3 days and increasing to 100 mg daily. Haemoglobin stabilised rapidly, and transfusion requirements fell substantially within 2 weeks of drug commencement.
Case 2 was a 60-year-old woman on long-term haemodialysis for lupus nephritis with a failed kidney transplant. During admission for type B aortic dissection treated with thoracic endovascular aortic repair, she developed prolonged recurrent melaena. Despite repeated oesophagogastroduodenoscopies, argon plasma coagulation, capsule endoscopy, octreotide, and multiple activations of the major haemorrhage protocol, bleeding persisted. Thalidomide 50 mg daily was introduced as salvage therapy. Within four weeks of drug commencement, transfusion requirements decreased from 1–2 units daily to once every 4-7 days.
Discussion
Thalidomide may reduce angiodysplasia-related bleeding through anti-angiogenic effects mediated by suppression of vascular endothelial growth factor. These cases support its potential role as salvage therapy in selected patients with advanced CKD or ESKD and refractory gastrointestinal angiodysplasia bleeding.