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Uremic encephalopathy in patients undergoing assisted peritoneal dialysis: a case series and literature review

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Abstract

We sometimes hesitate to switch renal replacement therapy from peritoneal dialysis (PD) particularly in elderly patients due to their physical tolerance levels and lifestyles. Here, we describe the cases of three patients treated with PD alone despite an anuric status who subsequently developed uremic encephalopathy, which was successfully treated with hemodialysis (HD). The first patient was a 75-year-old woman who developed uremic encephalopathy with an anuric status and inadequate PD after 7 months of treatment. HD immediately improved her condition; encephalopathy did not recur with combined therapy of PD and HD. The second patient was a 69-year-old woman who developed anuria and was treated with combined therapy. Her arteriovenous fistula was obstructed; therefore, she was treated with PD alone. Total weekly Kt/V was sufficiently high at 1.95; however, she developed uremic encephalopathy the following month, which was successfully treated with HD. The third patient was an 84-year-old woman who developed anuria, but was treated with PD alone with adequate total weekly Kt/V of 2.2. PD could not be performed for 2 days because of myocardial infarction intervention; subsequently, she developed uremic encephalopathy, which was successfully treated with HD. These cases are the first of their kinds, wherein patients undergoing PD, developed uremic encephalopathy without any obvious triggers, including drugs, and illustrate the necessity of initiating combined therapy for such patients considering the risk of developing severe uremia leading to uremic encephalopathy, in spite of it being less preferable for elderly patients due to their physical conditions and lifestyles.

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Authors and Affiliations

  1. Division of Nephrology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan

    Akane Yanai & Yoshitaka Ishibashi

  2. Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Kiyotaka Uchiyama

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  1. Akane Yanai
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  2. Kiyotaka Uchiyama
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  3. Yoshitaka Ishibashi
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Correspondence to Akane Yanai.

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All procedures performed in this case report were in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This case series was granted exemption from review by the ethics committee of the Japanese Red Cross Medical Center.

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Yanai, A., Uchiyama, K. & Ishibashi, Y. Uremic encephalopathy in patients undergoing assisted peritoneal dialysis: a case series and literature review. CEN Case Rep 8, 271–279 (2019). https://doi.org/10.1007/s13730-019-00406-3

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  • DOI: https://doi.org/10.1007/s13730-019-00406-3

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