PS-R06-1: A CASE OF PATIENT WITH END-STAGE KIDNEY DISEASE INTRODUCED HEMODIALYSIS AFTER CEREBRAL HEMORRHAGE.

Abstract

A 46-year-old male had been treated for end-stage kidney disease due to diabetic nephropathy and adaptive FSGS, and underwent surgery of arteriovenous fistula 3 weeks before the admission. He was scheduled to be introduced hemodialysis, but was urgently hospitalized due to cerebral hemorrhage. The head CT scan showed a subcutaneous hematoma of about 45 ml in the left frontal lobe, and the patient had impaired consciousness and worsening respiratory status. There were no surgical indications for cerebral hemorrhage, we initiated blood pressure control with nicardipine. Hyperkalemia was also seen, but urgent dialysis was not necessary, and we planned to introduce dialysis the next day or later. The next day hemodialysis was introduced, but soon after hemodialysis completed, worsening of respiratory condition and dilated pupil were observed. The head CT scan showed worsening cerebral edema compared to pre-dialysis CT scan on the same day. Thereafter, respiratory and general condition did not improve, and he died 11 days after the admission. It is recommended that dialysis should be avoided within 24 hours of the onset of cerebral hemorrhage because of the high risk of hematoma expansion. In addition, in the acute phase of cerebral hemorrhage, it is considered to choose a dialysis method that causes less intracranial pressure increase, such as peritoneal dialysis or continuous hemodiafiltration dialysis, if possible. Administration of hypertonic glycerol may also be helpful. When a patient with end-stage kidney disease is introduced hemodialysis soon after cerebral hemorrhage, control of blood and intracranial pressure should be cared.