From the Guidelines
For a dialysis patient experiencing a gastrointestinal (GI) bleed, intranasal desmopressin (DDAVP) can be considered as a treatment option, particularly in cases of coagulopathy or thrombopathy, as suggested by the European Heart Journal study 1. When managing a GI bleed in a dialysis patient, it's crucial to consider the underlying causes of the bleed and the patient's overall condition.
- The use of DDAVP may be beneficial in improving platelet function and reducing bleeding risk, especially in patients with uremic platelet dysfunction.
- The recommended dosage of DDAVP is typically 300 mcg (0.3 mg) administered intranasally, which can be divided as one spray (150 mcg) in each nostril, with effects lasting 4-8 hours.
- However, it's essential to monitor for potential side effects, including hyponatremia, headache, facial flushing, and hypotension, and use DDAVP cautiously in patients with cardiovascular disease or hypertension.
- In addition to DDAVP, other supportive measures should be continued, including correcting anemia with transfusions if needed, addressing the underlying cause of the GI bleed, and temporarily adjusting anticoagulation used during dialysis if appropriate, as outlined in the management of bleeding complications 1.
- It's also important to note that the European Heart Journal study 1 suggests considering dialysis as a measure to manage bleeding, particularly in cases of severe renal insufficiency, highlighting the need for a comprehensive approach to managing GI bleeds in dialysis patients.
From the Research
Treatment of GI Bleed in Dialysis Patients with Nasal DDAVP
- The use of nasal DDAVP (desmopressin) in treating GI bleed in dialysis patients is supported by studies that show its effectiveness in improving bleeding times in patients with chronic renal failure 2.
- DDAVP works by increasing platelet serotonin uptake and ATP release, which helps to regulate bleeding times 2.
- However, the studies do not specifically address the use of nasal DDAVP in treating GI bleed in dialysis patients, but rather its use in improving bleeding times in general.
GI Bleed in Dialysis Patients
- GI bleeding is a common complication in patients with chronic kidney disease and end-stage renal disease, and is associated with higher mortality rates compared to the general population 3, 4, 5.
- The causes of GI bleeding in dialysis patients can vary, but common causes include angiodysplasia, erosive esophagitis, and chronic gastric ulcer 6, 5.
- Dialysis patients with GI bleeding are at a higher risk of mortality, longer hospital stays, and increased healthcare utilization compared to those without renal disease 4.
Management of GI Bleed in Dialysis Patients
- Endoscopy is an important diagnostic and therapeutic tool in managing GI bleeding in dialysis patients, and is associated with lower mortality rates 4.
- However, dialysis patients are less likely to undergo endoscopic evaluation compared to those without renal disease, which can lead to delayed diagnosis and treatment 4.
- The management of GI bleeding in dialysis patients requires a multidisciplinary approach, including the use of medications such as DDAVP, as well as endoscopic and surgical interventions as needed.