Abstract: TH-PO0917
Outside the Circuit: Urgent Peritoneal Dialysis in a Jehovah's Witness with Myeloperoxidase (MPO)-ANCA Vasculitis
Session Information
- Home Dialysis: Utilization Patterns, Complications, and Quality-of-Life Outcomes
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Raman, Shakthi, NYC Health + Hospitals / Elmhurst, Icahn School of Medicine at Mount Sinai, Queens, New York, United States
- Burgos Guntin, Eusebio Felipe, NYC Health + Hospitals / Elmhurst, Icahn School of Medicine at Mount Sinai, Queens, New York, United States
- Sanchez Trinidad, Jeanette Marie, NYC Health + Hospitals / Elmhurst, Icahn School of Medicine at Mount Sinai, Queens, New York, United States
- McGee, James, NYC Health + Hospitals / Elmhurst, Icahn School of Medicine at Mount Sinai, Queens, New York, United States
Introduction
Patients with dialysis-dependent renal failure who require a bloodless strategy present a unique clinical challenge. Standard hemodialysis carries inherent risk of extracorporeal blood loss and requires anticoagulation, necessitating alternative modalities in this population.
Case Description
A 64-year-old female Jehovah's Witness presented from an outside hospital after being newly diagnosed with MPO-positive p-ANCA vasculitis following weeks of vomiting, abdominal pain, leg swelling, and brown urine. She had received pulse methylprednisolone and two hemodialysis (HD) sessions via a temporary catheter. Renal biopsy was deferred due to severe anemia. The patient had opted for a patient-directed discharge after reporting feeling pressured to undergo transfusions.
Exam on new admission showed tachycardia, hypertension, bibasilar decreased breath sounds, bilateral pitting edema, and asterixis. Renal and metabolic labs: creatinine 12.62 mg/dL, BUN 175 mg/dL, Hgb 6.6 g/dL. ANCA panel: MPO 3.6 (elevated), p-ANCA 1:80 rising to 1:160; Broad autoimmune and serologic workup was otherwise negative; SSA >8; C3/C4 normal.
Bloodless measures included erythropoietin 20,000 units daily. Peritoneal dialysis (PD) was selected over HD to eliminate extracorporeal blood loss. A catheter was placed and utilized within 48 hours without complication. Initial exchanges used a deliberately low fill volume of 1L (5 exchanges over 10 hours, 1.5% dextrose) to minimize intraperitoneal pressure and hemodynamic stress. BUN, Cr, and Hgb improved to 109 mg/dL, 7.05 mg/dL, and 7.1 g/dL respectively at discharge, with resolution of symptoms.
Discussion
In situations with dialysis-dependent renal failure, RRT modality selection carries implications beyond clearance alone. HD risks unrecoverable blood loss through circuit clotting and requires anticoagulation. PD eliminates extracorporeal blood exposure, provides uremic and fluid control without systemic anticoagulation. Most commonly, PD catheter usage is initiated approximately two weeks after placement. Though urgent PD is rare, this case demonstrates feasibility within 48 hours. Nephrologists managing renal failure in settings requiring bloodless medicine should integrate RRT modality planning guided by patient values and hemorrhagic risk. Early bloodless medicine consultation and anemia optimization are equally essential.