A CASE OF BLEEDING MULTIPLE TELANGIECTASIAS OF INTESTINE IN A DIALYSIS PATIENT ON LONG TERM HYPOXIA INDUCIBLE FACTOR - PROLYL HYDROXYLASE INHIBITOR(HIF-PHI) TREATMENT

E-Poster

https://storage.unitedwebnetwork.com/files/1099/d241773344ffbd04d786f228eb34e02a.pdf

Abstract Title

First Name *

Tarun kumar

Last Name *

Saha

Co-author 1

Vamsi Krishna Nagalla vamsicul@gmail.com Yashoda Hospital Secunderabad Nephrology Hyderabad

Co-author 2

Rakesh Kumar Adi rakeshkumaradi@yahoo.co.in Yashoda Hospital Secunderabad Gastroenterology Hyderabad

Co-author 3

Prasad Babu TLVD drprasadbabu@yahoo.com Yashoda Hospital Secunderabad Surgical Gastroenterology Hyderabad

Co-author 4

Bhakti Bhaskaruni bhaktilathker@gmail.com Yashoda Hospital Secunderabad Nephrology Hyderabad

Co-author 5

Sumana Sen sumanadrsen@gmail.com Apollo Institute of Medical Sciences & Research Pharmacology Hyderabad

Co-author 6

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

GastroIntestinal Bleeding (GIB) is one of the major complications of chronic kidney disease(CKD) patients on dialysis. We report an interesting and difficult to manage case of GIB in a diabetic CKD patient with multiple comorbidities on maintenance hemodialysis(MHD).

Methods

A 60 year old diabetic lady developed CKD stage 5 and was started on MHD in 2019, next year she underwent hysterectomy for localized Endometrial Carcinoma. She developed Erythropoetin resistant anemia with high Ferritin level (756 mcg/L) in late 2020. She was started on HIF-PHI Desidustat 100 mg thrice a week and her Hemoglobin(Hb) improved. The dose was modified intermittently as per Hb level. In 2022 she underwent surgery for intertrochanteric fracture of femur. In 2023, she underwent total hip arthoplasty and was put on Rivaroxaban. Desidustat was stopped before surgery. She had melena and drop in Hb after 2 weeks of surgery. She required multiple packed red blood cell (PRBC) transfusions and anticoagulant was stopped. Upper Gastro Intestinal(UGI) Endoscopy followed by Colonoscopy and CT

Results

Although efficacy of HIF-PHIs in correcting renal anemia has been demonstrated in several randomized controlled trials, the safety profiles of these agents are lacking, especially in the real-world setting. It is documented that some genes that are induced by HIF activation are related to tumor formation and progression, including vascular endothelial growth factor (VEGF). United States Food and Drug Administration adverse event Reporting System data might suggest an increased risk of GI hemorrhage when using HIF-PHIs. Abnormal angiogenesis in the GI tract could be regulated by HIF, by directly targeting the VEGF pathway. A few studies have shown that thalidomide is an effective and relatively safe therapy for preventing recurrent bleeding in angiodysplastic disorders by inhibiting VEGF. The dose adjustment is not necessary in hemodialysis patients.

Conclusions

Intractable GI bleeding due to multiple telangiectasias is an uncommon complication of CKD but it may pose diagnostic and therapeutic challenges. Thalidomide is useful for refractory GIB in patients who can tolerate the drug. The possible etiological role of HIF-PHI for intestinal telangiectasias needs to be considered.

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