Abstracts

Rationale: Epoetin-alfa is a colony-stimulating factor used to treat anemia of chronic kidney disease and end stage renal disease (ESRD). Epoetin has several neuroprotective effects in ischemic, traumatic, convulsive and neurodegenerative brain diseases. However, its administration may cause hypertension, convulsions, hypertensive encephalopathy and influenza-like syndrome. Hyperkalemia is a rare but possible side effect of epoetin. We report a patient who developed polycythemia, hypertension, seizures and persistent hyperkalemia secondary to epoetin use.Methods: This is retrospective evaluation of a patient was admitted with multiple seizures and persistent hyperkalemia who received epoetin-alfa.Results: Our patient is a 43 years old South-Asian female with past medical history of hypertension, ESRD on hemodialysis presenting with generalized tonic-clonic seizure after being treated with epoetin for few weeks. Laboratory evaluation on admission revealed Hemoglobin 18.1, Hematocrit 57.1, Potassium 6.6, S.Creatinine 9.9 and LDH 307. Her neuroimagings were unremarkable. She had one unremarkable interictal EEG. Her potassium remained persistently elevated even after consecutive dialysis. Her potassium level decreased over 7-10 days once epoetin was discontinued. She did not have any seizures after discontinuation of epoetin.Conclusions: Epoetin has been effective in reversal of anemia in patients with ESRD. It is well tolerated and has several neuroprotective effects and it has few rare side effects. Along with recently reported increased incidence of cardiovascular events, when the hemoglobin exceeds 12, neurological and hyperkalemic effects also need to be monitored. To our knowledge, this is the only case report described in literature.