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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Gastrointestinal (GI) angiodysplasia is a frequently encountered problem and the most frequent cause of recurrent bleeding in patients with hemodialysis, currently lacks standardized therapeutic protocols. Elevated vascular endothelial growth factor (VEGF) levels in hemodialysis populations and the demonstrated efficacy of thalidomide in GIVD management provide a potential therapeutic avenue. Nevertheless, clinical evidence regarding thalidomide's application for refractory gastrointestinal bleeding in this specific cohort remains scarce.
We present a 40-year-old male with IgA nephropathy progressing to end-stage renal disease (ESRD), maintained on hemodialysis for 17 months, who manifested recurrent gastrointestinal bleeding over 5 months. Multiple gastroscopy examinations did not show any bleeding. After fasting and treatment with octreotide, the bleeding temporarily improved. Despite intensive iron supplementation (polysaccharide iron complex 0.3g daily) and erythropoietin therapy (EPO 4000u TIW), laboratory parameters revealed persistent anemia (Hb 60-70 g/L) and iron deficiency (serum iron 6-11 µmol/L). Upon readmission with exacerbated anemia (Hb 56 g/L) and fatigue, diagnostic workup showed: RBC 2.01×10¹²/L, PLT 98×10⁹/L, 3+ fecal occult blood, CRP 5.7 mg/L, and characteristic renal metabolic derangements (pre-dialysis Cr 804 µmol/L, K+ 6.3 mmol/L),autoantibodies and tumor markers were negative, and abdominal CT revealed no specific abnormalities. Colonoscopy demonstrates multiple spider-like vascular dilatations in the ileocecal region(Figure),comprehensive imaging and endoscopic evaluation ultimately identified colonic telangiectasias via colonoscopy, while excluding other bleeding sources. Following ethical approval andpatient consented, thalidomide therapy was initiated(50mg qd po).
Fecal occult blood turned negative within 5 days of treatment initiation. Post-discharge therapy continuation included ongoing EPO administration and oral iron supplementation. Hemoglobin levels demonstrated progressive improvement:68 g/L at 1-month follow-up,80 g/L at 2-month follow-up.Thalidomide was discontinued per protocol at the 2-month mark. At the 3-month post-discontinuation assessment:Hemoglobin remained stable at 85 g/L,no recurrent gastrointestinal bleeding,persistent absence of fecal occult blood.
Colonoscopy proves instrumental in diagnosing refractory gastrointestinal bleeding during maintenance hemodialysis. Thalidomide demonstrates clinical efficacy for hemodialysis-associated intestinal vascular dysplasia-related hemorrhage, likely mediated through inhibition of vascular endothelial growth factor production.
Declaration of Generative AI and AI-assisted technologies in the writing process:I did not use generative AI and AI-assisted technologies in the writing process.
