Keyword: Sepsis
2 results found.
Congress Abstract
Central Asian Journal of Nephrology, 2(2, Suppl. 1), 2026, cajn_A30, https://doi.org/10.63946/cajn/19535
ABSTRACT:
Introduction: Catheter-related bloodstream infections remain a major cause of morbidity in patients receiving maintenance dialysis. Management becomes particularly challenging in kidney transplant recipients with failed allografts because of persistent immunosuppression, severe systemic inflammation, and a high risk of thrombotic complications. Hemoadsorption has emerged as a promising adjunctive extracorporeal therapy for sepsis by reducing circulating inflammatory mediators. We present a case of successful integration of HA-330 hemoadsorption into the treatment of severe catheter-related sepsis in a patient with end-stage kidney disease.
Case Presentation: A 28-year-old woman with kidney failure secondary to glomerular disease underwent living-donor kidney transplantation in 2014. Following allograft rejection in 2024, she resumed maintenance hemodialysis. She was admitted with fever, weakness, chest pain, and signs of systemic infection. Blood cultures obtained from peripheral blood and the dialysis catheter grew Staphylococcus haemolyticus. Diagnostic evaluation revealed catheter-related sepsis, a fixed right atrial thrombus, bilateral pneumonia, severe anemia, and end-stage kidney disease requiring renal replacement therapy.
The patient received broad-spectrum antimicrobial treatment, anticoagulation, blood transfusions, and extracorporeal support. Two sessions of HA-330 hemoadsorption were performed in combination with hemodiafiltration
A marked reduction in inflammatory biomarkers was observed during treatment. C-reactive protein decreased from 335.1 to 28.7 mg/L (91% reduction), procalcitonin from 98.2 to 1.48 ng/mL (98.5% reduction). Leukocyte count decreased from 18.4×10⁹/L to 8.6×10⁹/L (Table №1). Follow-up echocardiography demonstrated a reduction of the right atrial thrombus from 30×14 mm to 16×11 mm. Repeat blood cultures were sterile, and the patient showed significant clinical improvement with resolution of systemic inflammatory manifestations.
The patient was discharged in stable condition for continuation of maintenance hemodialysis.
Conclusion: This case demonstrates the potential value of HA-330 hemoadsorption as an adjunct to standard therapy in severe catheter-related sepsis among dialysis patients with failed kidney transplants. Combined hemoadsorption and hemodiafiltration may contribute to clinical stabilization and recovery in complex septic conditions, warranting further investigation in larger patient cohorts.
Case Presentation: A 28-year-old woman with kidney failure secondary to glomerular disease underwent living-donor kidney transplantation in 2014. Following allograft rejection in 2024, she resumed maintenance hemodialysis. She was admitted with fever, weakness, chest pain, and signs of systemic infection. Blood cultures obtained from peripheral blood and the dialysis catheter grew Staphylococcus haemolyticus. Diagnostic evaluation revealed catheter-related sepsis, a fixed right atrial thrombus, bilateral pneumonia, severe anemia, and end-stage kidney disease requiring renal replacement therapy.
The patient received broad-spectrum antimicrobial treatment, anticoagulation, blood transfusions, and extracorporeal support. Two sessions of HA-330 hemoadsorption were performed in combination with hemodiafiltration
A marked reduction in inflammatory biomarkers was observed during treatment. C-reactive protein decreased from 335.1 to 28.7 mg/L (91% reduction), procalcitonin from 98.2 to 1.48 ng/mL (98.5% reduction). Leukocyte count decreased from 18.4×10⁹/L to 8.6×10⁹/L (Table №1). Follow-up echocardiography demonstrated a reduction of the right atrial thrombus from 30×14 mm to 16×11 mm. Repeat blood cultures were sterile, and the patient showed significant clinical improvement with resolution of systemic inflammatory manifestations.
The patient was discharged in stable condition for continuation of maintenance hemodialysis.
Conclusion: This case demonstrates the potential value of HA-330 hemoadsorption as an adjunct to standard therapy in severe catheter-related sepsis among dialysis patients with failed kidney transplants. Combined hemoadsorption and hemodiafiltration may contribute to clinical stabilization and recovery in complex septic conditions, warranting further investigation in larger patient cohorts.
Congress Abstract
Central Asian Journal of Nephrology, 2(2, Suppl. 1), 2026, cajn_A24, https://doi.org/10.63946/cajn/19514
ABSTRACT:
Background: Patients with type 2 diabetes mellitus (T2DM) on maintenance hemodialysis represent one of the highest-risk populations in nephrology practice. End-stage kidney disease (ESKD) and T2DM create a state of profound immunosuppression that predisposes patients to life-threatening infections.
Central venous catheters (CVCs), frequently required for hemodialysis access, are a well-recognized gateway for bacteremia. When bacteremia is complicated by coagulopathy, the clinical course can rapidly evolve toward disseminated intravascular coagulation (DIC).
Case Presentation: A 58-year-old woman was admitted with a 3-day history of nausea, vomiting, and body pain. Examination revealed anasarca, lower-extremity purpura, and petechial rash, with concern for coagulopathy. T2DM diagnosed in 2007 and ESKD on maintenance hemodialysis since October 2025 (three 4-hour sessions weekly). Vascular access was a right internal jugular CVC.
On admission, hemoglobin 62 g/L, RBC 2.02 ×10¹²/L, platelets 93 ×10⁹/L, WBC 11.18 ×10⁹/L, glucose 24.28 mmol/L, total protein 63 g/L, D-dimer 2,680 ng/mL, procalcitonin (PCT) 14.8 ng/mL, creatinine 405 μmol/L, urea 13.9 mmol/L, INR 1.46, Prothrombin Index 66%, fibrinogen 4.0 g/L, APTT 28.2 sec. Antibiotics had been started at home without improvement. In hospital, broad-spectrum therapy was escalated to a carbapenem plus a fluoroquinolone, with packed red blood cell and fresh frozen plasma transfusions. Hemoglobin increased to 87 g/L, PCT decreased to 1.78 ng/mL, and D-dimer to 1,178 ng/mL; thrombocytopenia persisted. After treatment, creatinine 592 μmol/L, urea 20.7 mmol/L, glucose 16.55 mmol/L, albumin 26 g/L, total protein 53 g/L, INR 1.39, Prothrombin Index 69%, fibrinogen 7.55 g/L, APTT 25.4 sec.
On days 5–6, livedo reticularis, worsening dyspnea, and persistent coagulopathy prompted chest MSCT. It revealed bilateral peribronchial foci with formed cavities, consistent with abscessing (necrotizing) pneumonia. The bilateral cavitary pattern suggested hematogenous dissemination, likely from the indwelling CVC. Patient transferred to the ICU with sepsis-associated DIC.
Linezolid 600 mg IV twice a day was added to provide coverage for possible methicillin-resistant Staphylococcus aureus and other gram-positive organisms. Following treatment escalation, hemoglobin reached 118 g/L, PCT decreased to 0.9 ng/mL, INR normalized to 0.92, and Prothrombin Index increased to 117%.
Conclusion: CVC-related bacteremia should be considered early in hemodialysis patients with unexplained coagulopathy or bilateral pulmonary infiltrates. Purpura followed by livedo reticularis may indicate DIC progression and should prompt urgent reassessment. Cavitation despite antibiotics signals treatment failure and need to reassess pathogen coverage, including biofilm-forming gram-positive organisms. T2DM and ESKD create a multiplicative immunocompromised state, requiring multimodal management and glycemic control.
Central venous catheters (CVCs), frequently required for hemodialysis access, are a well-recognized gateway for bacteremia. When bacteremia is complicated by coagulopathy, the clinical course can rapidly evolve toward disseminated intravascular coagulation (DIC).
Case Presentation: A 58-year-old woman was admitted with a 3-day history of nausea, vomiting, and body pain. Examination revealed anasarca, lower-extremity purpura, and petechial rash, with concern for coagulopathy. T2DM diagnosed in 2007 and ESKD on maintenance hemodialysis since October 2025 (three 4-hour sessions weekly). Vascular access was a right internal jugular CVC.
On admission, hemoglobin 62 g/L, RBC 2.02 ×10¹²/L, platelets 93 ×10⁹/L, WBC 11.18 ×10⁹/L, glucose 24.28 mmol/L, total protein 63 g/L, D-dimer 2,680 ng/mL, procalcitonin (PCT) 14.8 ng/mL, creatinine 405 μmol/L, urea 13.9 mmol/L, INR 1.46, Prothrombin Index 66%, fibrinogen 4.0 g/L, APTT 28.2 sec. Antibiotics had been started at home without improvement. In hospital, broad-spectrum therapy was escalated to a carbapenem plus a fluoroquinolone, with packed red blood cell and fresh frozen plasma transfusions. Hemoglobin increased to 87 g/L, PCT decreased to 1.78 ng/mL, and D-dimer to 1,178 ng/mL; thrombocytopenia persisted. After treatment, creatinine 592 μmol/L, urea 20.7 mmol/L, glucose 16.55 mmol/L, albumin 26 g/L, total protein 53 g/L, INR 1.39, Prothrombin Index 69%, fibrinogen 7.55 g/L, APTT 25.4 sec.
On days 5–6, livedo reticularis, worsening dyspnea, and persistent coagulopathy prompted chest MSCT. It revealed bilateral peribronchial foci with formed cavities, consistent with abscessing (necrotizing) pneumonia. The bilateral cavitary pattern suggested hematogenous dissemination, likely from the indwelling CVC. Patient transferred to the ICU with sepsis-associated DIC.
Linezolid 600 mg IV twice a day was added to provide coverage for possible methicillin-resistant Staphylococcus aureus and other gram-positive organisms. Following treatment escalation, hemoglobin reached 118 g/L, PCT decreased to 0.9 ng/mL, INR normalized to 0.92, and Prothrombin Index increased to 117%.
Conclusion: CVC-related bacteremia should be considered early in hemodialysis patients with unexplained coagulopathy or bilateral pulmonary infiltrates. Purpura followed by livedo reticularis may indicate DIC progression and should prompt urgent reassessment. Cavitation despite antibiotics signals treatment failure and need to reassess pathogen coverage, including biofilm-forming gram-positive organisms. T2DM and ESKD create a multiplicative immunocompromised state, requiring multimodal management and glycemic control.