Peritoneal dialysis as a plausible option in morbus Osler: case report

At the age of 69 years, a woman with recurrent gastrointestinal bleeding underwent investigation by gastroscopy and colonoscopy. Extensive telangiectatic changes were observed in the canalis and antrum of the ventricle and in the colon. In parallel, the woman suffered from nephrotic syndrome, hypertension, and progressive renal failure attributable to chronic glomerular changes with extensive interstitialfibrosis. The progressive renal failure and recurrent gastrointestinal bleeds made frequent transfusions and erythropoietin injections necessary. Because of those complications, and because CAPD avoids the intermittent overhydration of a therapy such as hemodialysis and the risk of using anticoagulants, it was decided to perform continuous ambulatory peritoneal dialysis (CAPD) when dialysis became necessary. After CAPD was started, the woman's bleeding episodes decreased within 1 week. After 70 months of CAPD, the woman is well, without gastrointestinal bleeding. No transfusions have been necessary since the start of CAPD. For the now 77-year-old woman, data are as follows: epoetin beta dose, 12,000 U/week; body weight, 67 kg; hemoglobin, 130 g/L. The woman has experienced 1 episode of peritonitis since starting dialysis (6 months before the time of writing), because of a malfunction of the peritoneal dialysis device. No intestinal perforations have occurred. It seems worthwhile to try CAPD for dialysis in patients with morbus Osler