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NDT Plus Advance Access originally published online on November 25, 2008
NDT Plus 2009 2(1):67-71; doi:10.1093/ndtplus/sfn179
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Out of the blue

Ajay Dhaygude, Patrick MacDowall, Robert A. Coward and Alexander Woywodt

Renal Unit, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK

Correspondence: Correspondence and offprint requests to: Alexander Woywodt, Renal Unit, Lancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK. Tel: +0044-1772-524629; Fax: +0044-1772-523516; E-mail: Mail@Alexander-Woywodt.com

Key Words: haemodialysis • phosphodiesterase inhibitors • pulmonary hypertension • sildenafil • syncope

Received for publication October 21, 2008. Accepted for publication October 24, 2008.

The first 150 words of the full text of this article appear below.


   Introduction
 
Episodes of hypotension are common during haemodialysis sessions; they are usually related to volume depletion, presence of cardiac disease or both. Fortunately, severe hypotension with loss of consciousness, disappearance of peripheral pulses and pre-arrest is rare during haemodialysis. Such an event mandates a comprehensive assessment after the patient has been stabilized. We present the interesting case of a 73-year-old patient who was newly started on haemodialysis and sustained a pre-arrest during her fourth haemodialysis session.


   Case
 
A 73-year-old female patient with hypertensive nephrosclerosis was started on haemodialysis via a tunnelled line in July 2008. Her other comorbid conditions included atrial fibrillation and right heart failure with severe pulmonary hypertension (pulmonary artery pressure 83 mmHg) due to pulmonary emboli. Her medication included ramipril 5 mg once daily (OD), bisoprolol 3.75 mg OD (evenings) and sildenafil 25 mg three times daily. Following implantation of her tunnelled line, she underwent three uneventful haemodialysis sessions. . . . [Full Text of this Article]


   Discussion
 

   Conclusion
 

   Teaching points
 

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