Erythrocytosis associated with increased serum erythropoietin in a patient on hemodialysis

Abstract

The patient is a 56-year-old male undergoing hemodialysis since 1993. He was admitted to our hospital for the evaluation of erythrocytosis in 1997. His serum erythropoietin concentration was high. After some diagnostic investigations, the main causes of erythrocytosis were evaluated as sleep apnea syndrome, smoking, and hypotension during hemodialysis. Since sleep apnea syndrome had already been treated by otorhinological surgery, he was only prescribed weight control by dietary restriction and it was temporarily effective for controlling erythrocytosis. The evaluation of sleep apnea syndrome by apnomonitor was repeated in 2003, and the patient was classified as having severe disease. He, however, was again prescribed only weight control without continuous positive airway pressure (CPAP) therapy, because weight control had been effective. The patient was subsequently involved in a motor vehicle crash due to excessive daytime sleepiness. In this case, we should have initiated CPAP therapy earlier.