Abdominal angina in patients receiving long-term hemodialysis

The syndrome of abdominal angina is described in three patients receiving long-term hemodialysis. This clinical entity has not yet been described in patients with chronic renal failure. The classic triad of abdominal pain, weight loss, and diarrhea produces fear of eating. Most laboratory and radiologic investigations are inconclusive. Remarkable relief of symptoms occurs with maintenance of the hematocrit level above 30%, reduction of pump speed during hemodialysis to approximately 200 ml/min, use of a smaller surface area dialyzer, and administration of sublingual nitroglycerin. This clinical syndrome is often misdiagnosed, resulting in several unnecessary investigations, as well as unnecessary surgical procedures. Cholecystectomy is the operation most commonly done. All three of our patients died within ten months of diagnosis.