Abstract
This report describes a 72-year-old male who was initiated on hemodialysis in January 2006 because of chronic renal failure (original disease unknown). Following coronary artery bypass grafting (CABG) and mitral valve replacement (MVR), the patient was found to have diminished cardiac function, and was, therefore, initiated on hemodiafiltration ; however, during the procedure, marked hypotension occurred and the patient developed intradialytic symptoms. Therapy was thus changed to acetate-free dialysis (acetate-free biofiltration, or AFB) in August of the same year, but the patient showed sporadic premature ventricular contractions (PVCs) during dialysis and also hypotension, with persistence of the intradialytic symptoms. After medication for tachycardia, the patient required a backup pacemaker ; since he also had diminished cardiac function, a widened QRS duration and ventricular tachycardia (VT), implantation of an implantable defibrillator with dual-chamber pacing (cardiac resynchronization therapy defibrillator, or CRT-D) was deemed indicated. CRT-D implantation was conducted on September 15, 2006, with cardiovascular improvement being noted following the dual-chamber pacing. Echocardiography demonstrated improvement of the left ventricular diastolic diameter (LVDd), left ventricular mass (LVM) and cardiac function. The intradialytic hypotension and difficulty in ambulation decreased and VT also ceased to appear, allowing consistent dialysis.
