A case in which a pediatric hemodialysis patient could return to home and school life after the introduction of home hemodialysis

Abstract

The patient was a 9‒year and 1‒month‒old girl. She was started on peritoneal dialysis for end‒stage renal disease due to focal segmental glomerular sclerosis (FSGS). After 5 years, she underwent a renal transplantation. However, because of graft failure associated with the recurrence of FSGS shortly after transplantation, catheter‒based hemodialysis was initiated. To help the patient return to a more normal home and school life and experience adequate growth and development, she was referred to our clinic so that home hemodialysis (HHD) could be initiated. We explained about HHD to the patient and her parents and obtained written informed consent. HHD training was conducted twice a day, and we trained the patient’s mother and father for 6 and 5 days, respectively. As HHD safety mechanisms, we focused on setting appropriate water removal parameters using the blood volume system, instructions for catheter use, and the use of a videophone as a backup tool. The initial dialysis conditions were 5 times a week for 3 hours. About 2 months after HHD was initiated, the doses of antihypertensive agents were decreased, and the patient’s height and weight had improved. HHD was performed safely and allowed the patient a more normal life.