Abstract
The patient was a 74-year-old woman with a 5-year history of maintenance hemodialysis (HD) for end stage renal failure due to diabetes. Only one day after dialysis, she had already gained 3 kilograms, and after two days, she had gained 4.5 kilograms. This increase was serious. Since her blood pressure dropped severely at each HD session, she could not achieve dry weight by the standard method of dialysis 3 times per week. Therefore, she underwent HD+ECUM (extra corporeal ultrafiltration method) 5 times per week at maximum, and was able to achieve dry weight by the weekend. Then we tried to perform peritoneal dialysis (PD) together with HD in order to assist with fluid-removal from her body. After she was treated using 2L of icodextrin in two fractions, she could lose 800g of fluid/day on average. Using a combination of PD with HD, she gained 1kg one day after HD and 1.5kg after an interval of two days. Therefore, her fluid weight gain could be controlled using HD (ECUM) 3 times per week and she could reduce the time required for HD (ECUM) from 30hours to 9 hours per week. Thus, her quality of life was improved. Blood serum data were also improved. We think this is an appropriate choice for HD in a patient with difficulty achieving dry weight.
