Peritoneal Dialysis in a Patient with Acute Kidney Injury, Thrombocytopenia, Urosepsis, and Liver Cirrhosis: A Case Report
Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Educational Purpose (only if useful for a systematic review or synthesis), Rare co-existance of disease or pathology
Krzysztof Cieszyński, Alicja E. Grzegorzewska
Department of Internal Medicine with Nephrology and Rheumatology Units, Pleszew Medical Center, Pleszew, Poland
Am J Case Rep 2020; 21:e926226
Available online: 2020-08-25
We present the possibility of successful peritoneal dialysis (PD) treatment in acute kidney injury (AKI) patients with multiple comorbidities.
CASE REPORT: A 60-year-old woman with chronic kidney disease (CKD, stage G3b), liver cirrhosis (Child-Pugh class A score), and thrombocytopenia developed AKI due to urosepsis. Laboratory tests showed serum creatinine 430.5 µmol/L, urea 44.0 mmol/L, potassium 5.7 mmol/L, C-reactive protein 208 mg/L, procalcitonin 8 ng/mL, platelets 14×10⁹/L, hemoglobin 5.83 mmol/L, and albumin 30 g/L. Due to hemodynamic instability with profound hypotension and the potentially high bleeding risk when doing central venous catheter insertion or using anticoagulants, PD was selected as the AKI treatment. The PD catheter was implanted by the surgical method after the transfusion of platelet concentrate. Automated PD in tidal mode was implemented using 1.5% and 2.3% glucose: basic inflow volume 1200 mL and a tidal volume of 700 mL. Effective dialysis with ultrafiltration up to 1200 mL/day was achieved. The patient was discharged home in good condition. After 1 month, PD was discontinued due to the renal function returning to its pre-septic state of CKD category G3b. The PD catheter was removed 3 weeks later.
CONCLUSIONS: PD can be an effective method for AKI treatment in patients with sepsis, hemodynamic instability, thrombocytopenia, and liver cirrhosis.
Keywords: acute kidney injury, Liver Cirrhosis, Peritoneal Dialysis, Sepsis, Thrombocytopenia