PHLEBOTOMY FOR PULMONARY-EDEMA IN DIALYSIS PATIENTS

Study objective: To assess the efficacy of phlebotomy in the treatment of pulmonary edema in hemodialysis patients. Procedure: Maintenance h emodialysis patients presenting to the emergency room in respiratory d istress from apparent pulmonary edema were assessed with regard to cli nical response, change in blood pressure, change in hematocrit, and in terval until the next hemodialysis treatment. Results: Twenty-one pati ents underwent phlebotomy and seventeen improved markedly and did not require intubation or emergent dialysis. Hemodialysis was initiated 15 .6 +/- 13.6 SD hours later. Four were able to have their treatment 24 or more hours later. Thirteen of 21 (62%) were hypertensive at the tim e of treatment and blood pressure tended to normalize in this subset. Four of 21 (19%) developed transient hypotension without permanent seq uelae. Pre-mean hematocrit = 25.0 + 6.0 and post phlebotomy = 22.6 + 4 .6 SD. All patients receiving phlebotomy survived to hospital discharg e. Conclusion: Phlebotomy can often obviate the need for intubation or emergent dialysis in ESRD patients presenting with pulmonary edema.