Clinical characteristics of hemodialysis patients with non-occlusive mesenteric ischemia

Abstract

Non-occlusive mesenteric ischemia (NOMI) occurs more frequently in dialysis patients than in non-dialysis patients and is associated with an extremely poor prognosis. In many cases, however, direct triggers for NOMI remain unclear. This study was aimed to clarify the clinical characteristics of hemodialysis patients with NOMI and examine their relationship with the onset of NOMI. Nineteen patients with NOMI were divided into group A (n＝9) who had obvious triggers (cardiac surgery, cardiogenic and hemorrhagic shock) and group B (n＝10) with undetermined causes. Although APACHEⅡ scores tended to be lower in group B than in group A, there was a stronger tendency to have a history of arteriosclerotic diseases and the mortality rate was similar (group A：77.8％, group B：60％, p＝0.63). The dose of erythropoiesis-stimulating agents (ESAs) was higher in group B (7,000 vs. 3,000 U/week, respectively, p＝0.015) and the erythropoiesis resistance index (ERI) tended to be greater (12.9 vs. 4.3 U/kg/g/dL/week, respectively, p＝0.058). Group B showed weight loss and elevated hematocrit at the onset of NOMI. In conclusion, the mortality rate is high even in patients who have NOMI but no obvious triggers, such as cardiovascular surgery and cardiogenic/hemorrhagic shock. Underlying arteriosclerotic tendency, EPO doses/responsiveness, decreased circulating blood volume, and decreased mesenteric blood flow due to hemoconcentration and impaired blood fluidity may be involved in the development of NOMI.