A case of gastrointestinal bleeding probably associated with chronic liver disease, and worsened by CAPD

A 66-year-old female on CAPD had severe anemia (hematocrit: 20% or less) due to gastrointestinal bleeding probably associated with pre-existing chronic liver disease. She was admitted to our hospital on January 1, 1994, because of general fatigue, severe anemia, and a hematocrit of 11%. She was also found to have tunnel infection of her CAPD catheter. We therefore removed and replaced her CAPD catheter when after her hematocrit level had been increased to 28% or more by blood transfusion. After surgery we switched from CAPD to hemodialysis using nafamostat mesilate as an anticoagulant. During the first 6 weeks postoperatively, the severity and frequency of gastrointestinal bleeding decreased and her hematocrit was maintained in the 25-30% range. This case suggested that CAPD may contribute to the increased incidence of gastrointestinal bleeding in patients with chronic liver disease by increasing intra-abdominal pressure, hypoproteinemia, and CAPD-related underdialysis.