Hemodialysis-related portosystemic encephalopathy after transjugular intrahepatic portosystemic shunt: A case report and literature review

BACKGROUND Hemodialysis-related portosystemic encephalopathy (HRPSE) represents a form of dialysis-induced hepatic encephalopathy. We present a rare case of the portosystemic shunt tract being opened by transjugular intrahepatic portosystemic shunt (TIPS) in a cirrhotic patient to alleviate the symptoms of refractory ascites, in which encephalopathy symptoms recurred during the maintenance hemodialysis for this patient’s chronic renal failure. CASE PRESENTATION A 71-year-old female with cirrhosis and stage G5 chronic kidney disease (CKD) was admitted. A TIPS stent was placed because of portal hypertension with refractory ascites. Due to preexisting CKD requiring maintenance hemodialysis, hemodialysis continued post-TIPS. During the latter half of dialysis sessions at 2 weeks post-TIPS, the patient exhibited recurrent hepatic encephalopathy symptoms, including sluggish responses, incoherent answers, and progressive consciousness impairment. After excluding other neurological disorders, HRPSE was diagnosed. Ammonia-lowering interventions and dialysis prescription modification reduced encephalopathy incidence. CONCLUSION In cirrhotic patients with concurrent CKD, TIPS placement requires careful prior evaluation, and clinicians should remain alert for the development of HRPSE following the procedure