Recurrent Transient Ischemic Attacks While on Hemodialysis: A Case Report

Cerebrovascular accidents (CVAs) remain a crucial cause of morbidity and mortality while posing a significant burden to public health systems worldwide. Its incidence is higher in elderly patients with end-stage renal disease (ESRD) on hemodialysis due to concomitant conditions (advanced age, diabetes, cardiovascular disease, hypertension), altered cerebral blood flow, and frequent use of anticoagulants during hemodialysis treatments. In this report, we discuss a case of an 85-year-old female patient with ESRD on hemodialysis who started having recurrent episodes of transient ischemic attacks (TIA) that coincided with her dialysis treatments. Cerebral blood flow shunting during dialysis sessions was thought to be the likely cause of these events. After multiple failed attempts to convince the patient to transition to peritoneal dialysis, her dialysis prescription was modified to shorter duration treatments. With this modification, she experienced no further TIA episodes. This highlights the importance of an individualized approach to management decisions when there is a lack of clear treatment guidelines.