Shirsat Pallavi, Sonavane Kunal, Agarwal Bhawna, Agrawal Gautam
Nephrology, Minden Medical Center, Minden, USA.
Internal Medicine, Willis Knighton Health, Bossier City, USA.
Cureus. 2025 Apr 25;17(4):e83002. doi: 10.7759/cureus.83002. eCollection 2025 Apr.
Cerebrovascular accidents (CVAs) remain a crucial cause of morbidity and mortality while posing a significant burden to public health systems worldwide. Its incidence is higher in elderly patients with end-stage renal disease (ESRD) on hemodialysis due to concomitant conditions (advanced age, diabetes, cardiovascular disease, hypertension), altered cerebral blood flow, and frequent use of anticoagulants during hemodialysis treatments. In this report, we discuss a case of an 85-year-old female patient with ESRD on hemodialysis who started having recurrent episodes of transient ischemic attacks (TIA) that coincided with her dialysis treatments. Cerebral blood flow shunting during dialysis sessions was thought to be the likely cause of these events. After multiple failed attempts to convince the patient to transition to peritoneal dialysis, her dialysis prescription was modified to shorter duration treatments. With this modification, she experienced no further TIA episodes. This highlights the importance of an individualized approach to management decisions when there is a lack of clear treatment guidelines.
脑血管意外（CVA）仍然是发病和死亡的重要原因，同时给全球公共卫生系统带来巨大负担。由于合并症（高龄、糖尿病、心血管疾病、高血压）、脑血流改变以及血液透析治疗期间频繁使用抗凝剂，接受血液透析的终末期肾病（ESRD）老年患者中其发病率更高。在本报告中，我们讨论了一例85岁接受血液透析的ESRD女性患者，她开始出现与透析治疗同时发生的短暂性脑缺血发作（TIA）复发。透析期间的脑血流分流被认为是这些事件的可能原因。在多次试图说服患者转为腹膜透析但均失败后，她的透析处方被修改为较短疗程的治疗。通过这一修改，她没有再出现TIA发作。这突出了在缺乏明确治疗指南时采用个体化管理决策方法的重要性。
