Ori Y et al. (2005) Non-occlusive mesenteric ischemia in chronically dialyzed patients: a disease with multiple risk factors. Nephron Clin Pract 101: c87–c93

New dialysis methods might play a role in the increased incidence of non-occlusive mesenteric ischemia (NOMI), a dangerous condition that occurs most frequently in hemodialysis patients. Although intradialytic hypotension is a known risk factor, other contributing factors are unknown. Ori et al. carried out a retrospective, single-center analysis to investigate possible risk factors, and used their findings to construct an algorithm for the identification and treatment of high-risk patients.

The study included 20 patients (13 female, 7 male) who developed NOMI after dialysis for end-stage renal disease; 52 stable hemodialysis patients formed the control group. There were no significant differences in comorbid conditions or time on dialysis between the groups; abnormal echocardiographic findings were common in both groups.

Hypotension was detected in 18/19 hemodialysis patients in the NOMI group during pre-NOMI dialyses. Lower serum albumin levels, hemoconcentration, leukocytosis and metabolic acidosis were the most common laboratory findings on admission for NOMI. The dosage of recombinant human erythropoietin was significantly higher (P <0.05) and vascular medial calcifications were significantly more common (P <0.001) in the NOMI group than in the control group.

Although the best approach is still uncertain, the authors suggest an algorithm for the prevention of NOMI in high-risk patients (e.g. those with atherosclerosis, vascular calcifications or hypoalbuminemia). Suggestions include using the hematocrit to determine the level of immediate hydration, avoiding hypotension, reducing recombinant human erythropoietin dosage, performing abdominal ultrasound followed by arteriography and/or water-soluble, opaque-enema CT scan, selective use of intra-arterial papaverine, monitoring post-dialysis hemoglobin levels and weight, and carrying out surgery within 24 hours if therapy is unsuccessful.