PatrÃÆÃÂcia Aparecida Barbosa Silva, SÃÆÃÂ´nia Maria Soares, Gisele FrÃÆÃÂ¡guas, Fada Marina de, Oliveira Vaz, Maria JosÃÆÃÂ© da Silva, JosÃÆÃÂ© Gabriel da Silva JÃÆÃÂºnior, Luiz Augusto Fernandes da Silva
We describe the case of a male hypertensive patient with severe hemophilia A. In August 1999, he was admitted to our nephrology department, with hemarthrosis, severe hypertension, dyspnea with minimal efforts, increasing blood urea nitrogen, anemia, uremic symptoms, reduced urine volume, mild edema of lower limbs and no hyperkalemia. Image exams confirmed the diagnosis of End Stage Renal Disease. A Tenckhoff peritoneal dialysis catheter was inserted. He then started continuous ambulatory peritoneal dialysis. In August 2005 he evolved with peritoneal failure (peritoneal equilibration test showing ultra-filtration disorder-I), and was transferred to hemodialysis. A permanent catheter insertion into the right subclavian vein was scheduled. Hemodialysis sessions lasted 4 hours, three times a week, and gradually resulted in hemodynamic stabilization. In September 2005, an arteriovenous fistula was placed in the right forearm between the cephalic vein and the radial artery. In January 2007, the patient was admitted with abdominal and epigastric pain, double lumen catheter infection, peritoneal catheter infection, globoid tympanic abdomen and mild pain on palpation. Propaedeutics showed a large preperitoneal hematoma with bowel compression. Due to the catheter infection, we decided to puncture the fistula using a 17G needle. Apart from some bleeding during and after the beginning of hemodialysis, there were no other fistula complications. The patient evolved with progressive worsening of clinical symptoms, died in February 2007. In summary, an individualized treatment plan, mainly regarding adequate hemostatic monitoring, care of the dialysis access, multiprofessional and family involvement, may contribute to a successful management of hemophilia patients undergoing dialysis.
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