Nonocclusive mesenteric infarction in hemodialysis patients

Background: Dialysis patients develop nonocclusive mesenteric ischemia (NOMI) at an increased rate. Previous studies have associated atherosclerosis and hemodialysis-induced hypotension as inciting factors for NOMI development. 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 identify risk factors for the development of NOMI and for outcomes assessment. Study Design: All NOMI patients had hypotensive episodes during hemodialysis the week before the development of abdominal symptoms, and additional risk factors of hypertension (83%), diabetes (55%), and atherosclerosis (38%). The majority of patients (83%) experienced abdominal pain more than 24 hours before admission. Sixty-six percent of patients had leukocytosis on admission laboratory data. Results: Sixteen patients (55%) had ischemia of the small bowel, all underwent laparotomy, and nine (56%) died. Thirteen patients (45%) had ischemia of the colon and were managed nonoperatively; four (31%) of them died. Overall mortality rate for NOMI was 45%. Conclusions: NOMI occurs at an increased rate in hemodialysis patients. Identification of patients at high risk for NOMI and close monitoring of filtration rates may impact on the high mortality of this disease. (I Am Coll Surg 2000;190:84-88. (C) 2000 by the American College of Surgeons).