Abstract
A 57-year-old male, who had undergone maintenance hemodialysis (HD) for 35 years, suffered from a long period of HCV infection. He was treated with branched-chain amino acids, levocarnitine and lactulose syrup, and the concentration of bicarbonate in the dialysate was changed from 30 mEq/L to 25 mEq/L to prevent alkalemia. However, he developed repeated hepatic encephalopathy after HD. His liver was cirrhotic and multiple portal-systemic shunts were demonstrated by three-dimensional CT. When measured by color Doppler ultrasonography, the blood flow in the portal vein was decreased after HD. This decrease occurred because of direct flow into the systemic circulation through portal-systemic shunts due to a decrease in the intravenous pressure after HD. After the blood purification modality had been altered to hemodiafiltration (HDF) , the decrease in the portal blood flow was improved. The recurrent hepatic encephalopathy disappeared after the addition of aminoglycoside antibiotics and after the modality of blood purification therapy had been modified. On the basis of this experience, we discuss comprehensive measures to prevent hepatic encephalopathy in hemodialysis patients.
