From the Guidelines
Yes, there is a relationship between missing hemodialysis sessions and worsening angioedema in patients with impaired renal function. When patients with kidney disease miss their scheduled hemodialysis treatments, fluid and waste products accumulate in the body, which can trigger or exacerbate angioedema episodes. Hemodialysis helps remove excess fluid and inflammatory mediators that contribute to angioedema. Additionally, some medications used to treat angioedema, such as bradykinin inhibitors, are cleared by the kidneys and can accumulate to toxic levels in patients with renal impairment who miss dialysis. For patients with hereditary angioedema and kidney disease, consistent dialysis adherence is particularly important. The underlying mechanism involves the impaired clearance of bradykinin and other vasoactive peptides that cause blood vessel dilation and increased vascular permeability, leading to the characteristic swelling of angioedema. Patients should be educated about this connection and encouraged to maintain their regular dialysis schedule to help prevent angioedema flares. Any missed sessions should be reported to healthcare providers promptly so that medication adjustments can be made if necessary, as supported by recent guidelines on managing kidney dysfunction in advanced heart failure 1.
Some key points to consider in the management of angioedema in patients with impaired renal function include:
- The importance of maintaining a regular dialysis schedule to prevent the accumulation of fluid and waste products that can trigger or exacerbate angioedema episodes.
- The potential for medications used to treat angioedema to accumulate to toxic levels in patients with renal impairment who miss dialysis, as discussed in the context of ACE inhibitor therapy 1.
- The need for healthcare providers to be aware of the relationship between missing hemodialysis sessions and worsening angioedema, and to make medication adjustments as necessary.
- The potential benefits of using peritoneal dialysis as an alternative to hemodialysis in patients with angioedema and impaired renal function, as it may result in smaller hemodynamic shifts and a more patient-centric approach 1.
Overall, the relationship between missing hemodialysis sessions and worsening angioedema in patients with impaired renal function is complex and multifaceted, and requires careful management and education to prevent angioedema flares and improve patient outcomes.
From the Research
Relationship Between Missing Hemodialysis Sessions and Angioedema
- There is no direct evidence to suggest a relationship between missing hemodialysis sessions and worsening angioedema in patients with impaired renal function 2, 3, 4, 5, 6.
- However, it is known that angiotensin-converting enzyme inhibitors (ACEIs) can cause angioedema, and patients with renal failure may be more susceptible to this condition due to altered pharmacokinetics of ACEIs 5.
- Renal failure can lead to reduced elimination of ACEIs, resulting in increased peak plasma concentrations and area under the plasma concentration-time curve, which may increase the risk of angioedema 5.
- Hemodialysis can affect the clearance of ACEIs, and some ACEIs may require supplemental doses after dialysis to maintain therapeutic levels 5.
- Fluid retention, which can occur in patients with renal failure, may also contribute to discomfort and potentially worsen angioedema, although there is no direct evidence to support this relationship 6.
Mechanism of Angioedema in Renal Failure
- The exact mechanism of angioedema in renal failure is not fully understood, but it is thought to be related to the accumulation of bradykinin and other vasoactive peptides due to reduced renal clearance 2.
- ACEIs can increase bradykinin levels by inhibiting its breakdown, which may contribute to the development of angioedema in patients with renal failure 2.
- The use of ACEIs in patients with renal failure requires careful consideration of the potential risks and benefits, and close monitoring for signs of angioedema 4.