Anemia is a common complication in
end-stage renal disease (
ESRD) patients. On the other hand, idiopathic
erythrocytosis is extremely rare, with only a few cases reported in the literature. We present a case of
erythrocytosis that developed after initiating
hemodialysis. A 68-year-old male with a history of
ESRD secondary to diabetes presented with
erythrocytosis that started a few months after initiating dialysis in the absence of having received
erythropoietin-stimulating agents or
iron supplements. His
erythropoietin level was elevated, with a negative JAK2 mutation. Blood
gases showed normal
oxygen and CO(2), with slightly elevated
carboxyhemoglobin. Tiny foci in both kidneys were noted, representing
vascular calcifications or renolithiasis. There was no radiological evidence of
neoplasms or
cysts. After excluding secondary causes, a diagnosis of idiopathic
erythrocytosis was made. The patient underwent intermittent phlebotomies during dialysis, and his
hemoglobin went from 18.5 to 14 mg/dl.
Erythrocytosis in
ESRD patients is very rare. So far, there is no complete understanding of the underlying pathophysiology; however, there seem to be multiple possible reasons for an increased
erythropoietin level. Phlebotomy is a successful and easy way to control
erythrocytosis in such patients.
Angiotensin-converting enzyme inhibitors or
angiotensin receptor blockers, currently being used in posttransplant
erythrocytosis, might also be considered.