Kidney Week

Abstract: FR-PO494

Vasovagal Syncope during Peritoneal Dialysis

Session Information

• Home Dialysis - 1
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Waters, Claudia, Marshfield Clinic Health System, Marshfield, Wisconsin, United States

Claudia Waters, MD

• Shah, Neepa, Marshfield Clinic Health System, Marshfield, Wisconsin, United States

Neepa Shah, MD

• Kattamanchi, Siddhartha, Marshfield Clinic Health System, Marshfield, Wisconsin, United States

Siddhartha Kattamanchi, MD

• Blonsky, Rebecca, Marshfield Clinic Health System, Marshfield, Wisconsin, United States

Rebecca Blonsky, MD

Introduction

Vasovagal syncope can be difficult to predict for patients encountering new medical environments. Physicians must identify patients in which vasovagal syncope can interfere with their ability to reliably and safely participate in their care.

Case Description

A 65-year-old man with medical history significant for newly diagnosed ESRD due to IgA nephropathy who was recently started on peritoneal dialysis (PD) presented following a syncopal episode. The patient elected to start with in-center PD prior to dialyzing in his home. With his first ever fill he felt nauseated, but following this he tolerated treatments without symptoms. During his second week of treatment, he experienced a syncopal episode at the completion of his initial fill. His preceding symptoms included lightheadedness, nausea, tunnel vision, and dry heaving. He spontaneously awoke and completed the dwell under supervision of the nursing staff. He remained hemodynamically stable, however, was admitted for further evaluation. Laboratory workup was non-revealing, findings as per table one. Echocardiogram showed mild aortic stenosis which was stable from previous examination. Given the typical vasovagal-like prodrome coupled with an unremarkable cardiac workup, the patient was diagnosed with vasovagal syncope. His beta blocker was discontinued and inpatient PD was tolerated without recurrence of symptoms.

Discussion

Vasovagal syncope is an uncommon complication during early days of PD and usually happens during infusion of the PD fluid. In such scenarios alternate causes of syncope needs to be ruled out. When the cause is thought to be secondary to vasovagal syncope from PD infusion, then the rate of infusion must be lowered and attempted in a hospital setting to see if patient can tolerate this modality. Additionally, vagomimetic agents such as beta blockers should be lowered or stopped. With these interventions our patient was able to successfully remain on PD.