Nonocclusive mesenteric infarction in hemodialysis patients

Background: Dialysis patients develop nonocclusive mesenteric ischemia (NOM I) at an increased rate. Previous studies have associated atherosclerosis a nd hemodialysis-induced hypotension as inciting factors for NOMI developmen t. A retrospective review of 29 of 1,370 longterm hemodialysis patients who developed NOMI from January 1992 to December 1997 was performed. The NOMI patients were compared with a similar profile of hemodialysis patients to i dentify risk factors for the development of NOMI and for outcomes assessmen t. Study Design: All NOMI patients had hypotensive episodes during hemodialysi s the week before the development of abdominal symptoms, and additional ris k factors of hypertension (83%), diabetes (55%), and atherosclerosis (38%). The majority of patients (83%) experienced abdominal pain more than 24 hou rs before admission. Sixty-six percent of patients had leukocytosis on admi ssion laboratory data. Results: Sixteen patients (55%) had ischemia of the small bowel, all underw ent laparotomy, and nine (56%) died. Thirteen patients (45%) had ischemia o f the colon and were managed nonoperatively; four (31%) of them died. Overa ll mortality rate for NOMI was 45%. Conclusions: NOMI occurs at an increased rate in hemodialysis patients. Ide ntification of patients at high risk for NOMI and close monitoring of filtr ation rates may impact on the high mortality of this disease. (I Am Coll Su rg 2000;190:84-88. (C) 2000 by the American College of Surgeons).