Toprak Omer, Bozyel Emel A, Alp Burak, Kirik Ali
Department of Medicine, Division of Nephrology, Balikesir University School of Medicine, Balikesir, Turkey.
Department of Medicine, Division of Internal Medicine, Balikesir University School of Medicine, Balikesir, Turkey.
Am J Case Rep. 2021 Apr 25;22:e930857. doi: 10.12659/AJCR.930857.
BACKGROUND End-stage kidney disease patients who need hemodialysis for more than 3 months are less likely to be able to discontinue dialysis. Patient care, however, can play a role in improving kidney function. In this study, we showed that even a patient on hemodialysis for 8 years can discontinue or reduce the number of weekly dialysis sessions through kidney care. Here, we report the effect of patient care on the ability to cease dialysis or reduce dialysis sessions, discuss such cessation or reduction in chronic hemodialysis patients, and describe proper follow-up procedure for a patient whose dialysis has been discontinued or reduced. CASE REPORT Here, we present a 77-year-old man who had undergone hemodialysis 3 times weekly for 75 months, after which dialysis sessions were gradually decreased and terminated within 21 months while undergoing Toprak's Kidney Care, a kidney care program. The patient went without dialysis for 10 months. Then, hemodialysis was started once weekly for 46 months, as the glomerular filtration rate values decreased significantly. Following this period, he underwent hemodialysis 3 times weekly for 19 months. During these follow-up periods, 2 hospitalizations were required due to pneumonia and atrial fibrillation. There were no major adverse cardiac events. The patient is still in our follow-up care. CONCLUSIONS Gradual termination of an 8-year period of hemodialysis through a kidney care program without kidney transplantation is very rare. In end-stage kidney disease patients with adequate urination, kidney care should be considered to terminate hemodialysis or reduce the weekly dialysis sessions.
需要进行超过3个月血液透析的终末期肾病患者不太可能停止透析。然而，患者护理在改善肾功能方面可以发挥作用。在本研究中，我们表明，即使是一名接受了8年血液透析的患者，也可以通过肾脏护理停止透析或减少每周透析次数。在此，我们报告患者护理对停止透析或减少透析次数能力的影响，讨论慢性血液透析患者的这种停止或减少情况，并描述透析已停止或减少的患者的适当随访程序。病例报告：在此，我们介绍一名77岁男性，他每周进行3次血液透析，持续75个月，之后在接受肾脏护理项目Toprak's Kidney Care期间，透析次数在21个月内逐渐减少并终止。该患者10个月未进行透析。随后，由于肾小球滤过率值显著下降，每周进行1次血液透析，持续46个月。在此期间之后，他每周进行3次血液透析，持续19个月。在这些随访期间，因肺炎和心房颤动需要住院2次。未发生重大不良心脏事件。该患者仍在我们的随访护理中。结论：通过肾脏护理项目在未进行肾脏移植的情况下逐步终止8年的血液透析非常罕见。在尿量充足的终末期肾病患者中，应考虑进行肾脏护理以终止血液透析或减少每周透析次数。
