Eosinophilia in patients undergoing hemodialysis (HD) is rare but can cause severe complications including intradialytic hypotension. Hypereosinophilia-associated acute intradialytic hypotension (HAIDH) typically develops within minutes of HD initiation and does not respond to changes in the dialyzer or dialysate. In this report, we describe a case of HAIDH associated with idiopathic hypereosinophilic syndrome that was successfully managed with corticosteroids, and we review previously reported cases.
Background Erythropoiesis-stimulating agent hyporesponsiveness (HypoESA) poses a significant challenge in the management of anemia among dialysis patients. However, the absence of consensus regarding its definition and management has created an important gap between clinical guidelines and real-world practice. This study aimed to explore nephrologists’ perceptions and current practices related to the diagnosis and management of HypoESA. Methods A 26-item cross-sectional survey was administered online to nephrologists affiliated with the Busan-Ulsan-Gyeongnam chapter of the Korean Society of Nephrology. The survey assessed respondent demographics, clinical experience, perceptions of HypoESA, diagnostic approaches, management strategies, and perceived predictive factors. Survey data were analyzed using descriptive statistics. Results A total of 81 nephrologists responded to the survey (response rate, 38%). Substantial disagreement was observed regarding the definition of HypoESA, particularly with respect to criteria involving increases in ESA dosage. Chronic inflammation was most frequently identified as the primary underlying cause, with C-reactive protein considered the key diagnostic indicator. Increasing iron supplementation was reported as the most commonly preferred management strategy. Conclusions Despite broad recognition of chronic inflammation as a central factor in HypoESA, nephrologists demonstrated considerable variability in their definitions and management approaches, creating barriers to standardized care. These findings underscore the urgent need for a unified definition of HypoESA to better align clinical guidelines with everyday practice and ultimately improve patient outcomes.
