title: Challenges of caring for an advanced chronic kidney disease patient with severe thrombocytopenia.
abstract: An autogenous arteriovenous fistula has been considered to be the optimal form of vascular access for hemodialysis (HD) in the field of nephrology. Nevertheless, the decision regarding the type of access, whether it be an arteriovenous fistula, an arteriovenous graft, or a central venous catheter, must still be individualized. In the present report, we describe the case of a female patient with advanced chronic kidney disease (CKD) associated with a hemostatic disorder. Despite the exhausted peripheral vasculature, she required recurrent platelet transfusions for severe thrombocytopenia due to aplastic anemia. The goal of care for this patient was to optimize the dialysis treatment without increasing the bleeding risk. Various concerns regarding the therapeutic conundrums encountered in the case are also discussed.
authors: Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
authors: Tetsu
authors: T
authors: Akimoto
authors: Chiharu
authors: C
authors: Ito
authors: Atsushi
authors: A
authors: Kotoda
authors: Manabu
authors: M
authors: Ogura
authors: Taro
authors: T
authors: Sugase
authors: Ryuta
authors: R
authors: Sato
authors: Eiji
authors: E
authors: Kusano
authors: Daisuke
authors: D
authors: Nagata
keywords: advanced chronic kidney disease; aplastic anemia; platelet transfusion; thrombocytopenia; tunneled cuffed catheter