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Polycythemia in diabetic patients on CAPD
1Department of Medicine, University of Pittsburgh, PA.
Insights
Polycythemia, or high red blood cell count, is rare in continuous ambulatory peritoneal dialysis (CAPD) patients, particularly diabetics. This condition may increase the risk of serious vascular complications.
Area of Science:
- Nephrology
- Hematology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment for kidney failure.
- Polycythemia, characterized by elevated hematocrit (Hct) levels, is an uncommon complication in CAPD patients.
Observation:
- Over eight years, 3% of CAPD patients (4/123) developed polycythemia (Hct >50% for ≥1 month).
- All affected patients had insulin-dependent diabetes (8.5% of diabetic CAPD patients).
- Polycythemia developed after a mean of 21 months on CAPD, often with low ferritin and iron therapy.
Findings:
- Erythropoietin levels varied in affected patients.
- Renal ultrasounds did not reveal masses or cysts.
- Some patients experienced volume depletion.
Implications:
- Polycythemia in CAPD patients, especially diabetics, is associated with severe vascular complications including gangrene, stroke, and death.
- Volume depletion and iron therapy may contribute to polycythemia etiology.
- Monitoring and management of polycythemia in CAPD patients are crucial to prevent adverse outcomes.
Abstract:
Polycythemia in CAPD patients has been rarely described. Over an eight year period, 4 out of 123 CAPD patients (3%) were identified as having Hct values exceeding 50% for 1 month or longer. All of the 4 patients were insulin dependent diabetics (4/47 diabetic patients, 8.5%). Charts were reviewed on 3 of these 4 patients. Polycythemia developed after a mean of 21 +/- 7 months on peritoneal dialysis. Prior to the development of polycythemia, ferritin levels were low and ferrous sulfate therapy was begun at a time the Hct values were 36 to 40%. Erythropoietin levels were obtained in 2 patients, and were 22 U/L (Hct 51%) and less than 5 U/L (Hct 55%). Renal ultrasound failed to show renal masses or cysts. One patient had a plasma volume of 2.1 L (normal 2.4-3.2 L); another patient was clinically volume depleted. Complications during the period of polycythemia included gangrenous feet requiring amputation in 2 patients, CVA in 2 patients, and splenic infarct in 1 patient. One patient died of cerebral thrombosis. We conclude that polycythemia is uncommon in CAPD patients and occurs most often in diabetic patients. Volume depletion and iron therapy may play a role in its etiology. In this high risk group of patients polycythemia may contribute to vascular complications and should be avoided.