2012 Volume 3 Issue 1 Pages 46-52
Acute pulmonary edema (PE) is a frequent complication in emergency settings among hemodialysis patients. Frequently, emergency hemodialysis (HD) with ultrafiltration is effective for treating such patients. However, we occasionally encounter atypical PE that is nonresponsive to emergency HD. We tried to identify the clinical findings of and develop treatments for nonresponsive PE using a retrospective cohort study. Between April 1, 2008 and March 31, 2011, 93 hemodialysis patients with acute PE underwent emergency HD in the intensive care unit of our hospital. Clinical symptoms of 29 patients did not improve or became worse following emergency HD. We compared the clinical data on admission between the 64 patients who showed improvement (responder group) and the 29 patients whose respiratory failure did not improved with emergency HD (nonresponder group). Higher body temperature, lower arterial oxygen pressure, higher levels of C-reactive protein, and significantly higher lactate levels were observed in the nonresponder group. The cutoff level for the lactate was calculated as 1.90mmol/L with a sensitivity of 88.2% and a specificity of 96.8％ for differentiation of nonresponsive PE patients from others. We found that combination therapy of HD treatment with a polymethylmethacrylate (PMMA) dialyzer and administration of methylprednisolone is effective for nonresponsive PE. In conclusion, lactate levels proved to be an appropriate predictor for nonresponsive PE, and a combination therapy comprising HD with a PMMA dialyzer and short-term administration of methylprednisolone would be an acceptable treatment.
