Case Report: Simultaneous continuous renal replacement therapy and endovascular coiling in a poor-grade ruptured distal anterior cerebral artery aneurysm with ESKD and life-threatening hyperkalemia
- 1Department of Cerebrovascular Disease, Luzhou People’s Hospital, Luzhou, Sichuan, China
- 2Department of Neonatology, Luzhou People’s Hospital, Luzhou, Sichuan, China
- 3Department of Neurosurgery, Luzhou People’s Hospital, Luzhou, Sichuan, China
Abstract
BackgroundPoor-grade aneurysmal subarachnoid hemorrhage (aSAH) in patients with end-stage kidney disease (ESKD) on maintenance hemodialysis has traditionally been considered futile. Uremic platelet dysfunction and coagulopathy, electrolyte disturbances, and poor multi-organ reserve make these patients poor candidates for aggressive intervention. When a ruptured aneurysm coexists with life-threatening hyperkalemia, the therapeutic window narrows further, because severe hyperkalemia significantly increases the risk of perioperative arrhythmia and cardiac arrest and requires urgent correction. Continuous renal replacement therapy (CRRT) may offer advantages in this setting, but its use during neurointerventional procedures has rarely been reported.Case reportA 43-year-old woman with polycystic kidney disease and ESKD on regular hemodialysis presented with sudden coma and was diagnosed with Hunt-Hess grade V aSAH from a ruptured distal anterior cerebral artery (DACA) aneurysm. After 5 days of intensive care, her neurological status improved sufficiently to consider intervention. However, she developed life-threatening hyperkalemia (potassium 7.6 mmol/L). We performed simultaneous continuous renal replacement therapy (CRRT) and endovascular coiling. No anticoagulation was used in the CRRT circuit; intravenous heparin 0.67 mg/kg was administered separately for the neurointerventional procedure. CRRT was delivered in CVVHDF mode with a net ultrafiltration rate of 1−2 mL/kg/h and a total clearance of approximately 57 mL/kg/h, maintaining hemodynamic and intracranial stability throughout the 2-hour procedure. The aneurysm was completely obliterated (Raymond class I), and potassium decreased to 5.2 mmol/L. The patient recovered neurologically postoperatively but developed refractory bleeding during tracheostomy due to uremic platelet dysfunction and coagulopathy, ultimately leading to airway complications and death at 3 months.ConclusionSimultaneous CRRT and endovascular coiling was technically feasible in this carefully selected patient with poor-grade aSAH, ESKD, and life-threatening hyperkalemia. However, this is a single-case experience and cannot be generalized, and perioperative bleeding and airway management remained challenging.
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BibTeX
@article{song2026case,
title = {{Case Report: Simultaneous continuous renal replacement therapy and endovascular coiling in a poor-grade ruptured distal anterior cerebral artery aneurysm with ESKD and life-threatening hyperkalemia}},
author = {Zhifu Song and Yulan Gan and Xueping Huang and Wenyou Wu},
journal = {Frontiers in Surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1997449},
url = {https://doi.org/10.3389/fsurg.2026.1997449},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case Report: Simultaneous continuous renal replacement therapy and endovascular coiling in a poor-grade ruptured distal anterior cerebral artery aneurysm with ESKD and life-threatening hyperkalemia
AU - Zhifu Song
AU - Yulan Gan
AU - Xueping Huang
AU - Wenyou Wu
PY - 2026
DA - 2026/10/23
JO - Frontiers in Surgery
DO - 10.3389/fsurg.2026.1997449
UR - https://doi.org/10.3389/fsurg.2026.1997449
AB - BackgroundPoor-grade aneurysmal subarachnoid hemorrhage (aSAH) in patients with end-stage kidney disease (ESKD) on maintenance hemodialysis has traditionally been considered futile. Uremic platelet dysfunction and coagulopathy, electrolyte disturbances, and poor multi-organ reserve make these patients poor candidates for aggressive intervention. When a ruptured aneurysm coexists with life-threatening hyperkalemia, the therapeutic window narrows further, because severe hyperkalemia significantly increases the risk of perioperative arrhythmia and cardiac arrest and requires urgent correction. Continuous renal replacement therapy (CRRT) may offer advantages in this setting, but its use during neurointerventional procedures has rarely been reported.Case reportA 43-year-old woman with polycystic kidney disease and ESKD on regular hemodialysis presented with sudden coma and was diagnosed with Hunt-Hess grade V aSAH from a ruptured distal anterior cerebral artery (DACA) aneurysm. After 5 days of intensive care, her neurological status improved sufficiently to consider intervention. However, she developed life-threatening hyperkalemia (potassium 7.6 mmol/L). We performed simultaneous continuous renal replacement therapy (CRRT) and endovascular coiling. No anticoagulation was used in the CRRT circuit; intravenous heparin 0.67 mg/kg was administered separately for the neurointerventional procedure. CRRT was delivered in CVVHDF mode with a net ultrafiltration rate of 1−2 mL/kg/h and a total clearance of approximately 57 mL/kg/h, maintaining hemodynamic and intracranial stability throughout the 2-hour procedure. The aneurysm was completely obliterated (Raymond class I), and potassium decreased to 5.2 mmol/L. The patient recovered neurologically postoperatively but developed refractory bleeding during tracheostomy due to uremic platelet dysfunction and coagulopathy, ultimately leading to airway complications and death at 3 months.ConclusionSimultaneous CRRT and endovascular coiling was technically feasible in this carefully selected patient with poor-grade aSAH, ESKD, and life-threatening hyperkalemia. However, this is a single-case experience and cannot be generalized, and perioperative bleeding and airway management remained challenging.
SN - 2296-875X
ER -