Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 583 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

Table of Contents   
CASE REPORT  
Year : 2014  |  Volume : 25  |  Issue : 5  |  Page : 1056-1058
Thirty years survivor on hemodialysis: A case report


1 Kyanous Stavros Patron Dialysis Unit, Patras, Greece
2 Kyanous Stavros Patron Dialysis Unit, Patras, Greece; Krankenhaus Düren, Medizinische Klinik II, Düren, Germany

Click here for correspondence address and email

Date of Web Publication2-Sep-2014
 

   Abstract 

Hemodialysis is a widely performed and safe procedure; therefore, the numbers of long-term survivors on hemodialysis therapy have been increasing. We present a woman who had been on uninterrupted hemodialysis for 30 years and did well for much of her time on hemodialysis, despite a long-standing uneven course. The literature of extremely long-lived patients on un­interrupted hemodialysis is reviewed and the clinical characteristics and complications encountered in these patients are discussed.

How to cite this article:
Triga K, Dousdampanis P, Aggelakou-Vaitsi S, Gellner K. Thirty years survivor on hemodialysis: A case report. Saudi J Kidney Dis Transpl 2014;25:1056-8

How to cite this URL:
Triga K, Dousdampanis P, Aggelakou-Vaitsi S, Gellner K. Thirty years survivor on hemodialysis: A case report. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2019 Nov 14];25:1056-8. Available from: http://www.sjkdt.org/text.asp?2014/25/5/1056/139939

   Introduction Top


Since its introduction in 1960, maintenance hemodialysis has become a widely performed and quite safe procedure. [1],[2] Therapeutic stra­tegies have been developed, and the numbers of long-term survivors of hemodialysis therapy have been increasing. We present a patient who had been on uninterrupted hemodialysis for 30 years. She did extremely well for much of her time on hemodialysis. Significant health com­plications noted included multiple vascular access problems, cardiac insufficiency, arrhythmias, renal osteodystrophy, kyphoscoliosis, osteopenia resulting in fractures of her fingers after light trauma, severe secondary hyperparathyroidism and hepatitis C infection.


   Case Report Top


A 64-year-old woman was first diagnosed with chronic kidney disease due to chronic glomerulonephritis in 1979 when she was 34 years old. The following year, she was initiated on chronic in-center hemodialysis. Nevertheless, she managed to lead a normal life. She was married, completed two successful pregnancies and delivered twice - a healthy boy and a girl, who are now 35 and 36 years old. She felt well enough on dialysis to refuse renal transplan­tation.

In the early years, she suffered from low hematocrit levels that required blood transfusions every month. She had resigned from hard work and could walk around the house in order to conserve energy, because even standing made her breathless. After more than a decade of living with hematocrits of 16-22, she was started on the new erythropoietin and transfu­sions were not needed anymore to maintain high hemoglobin levels.

Most of her medical problems revolved around blood access. She was initiated on hemodialysis via an arteriovenous fistula in her left arm in 1979. She had at least two fistulas and four grafts placed in her upper extremities. In 2006, she had a permanent dialysis catheter placed in her left upper central venous system, which functioned until the time of her death in April 2009. In the following years, physically, she was somewhat less active than before. Her stamina was lower and she got out of breath a little easier than in the beginning years on dialysis. Whether this was related to aging or the long-term side-effects of dialysis is difficult to define. Her body was less tolerant of over indulgence than in the earlier years, and fluid removal exhausted her. Judging by tests that measure adequacy of dialysis, she was quite well dialyzed.

She was noted to become hepatitis C anti­body-positive in 1998 when she had an episode of occult gastric bleeding and, another nine years later, she regained her strength, with the sup­port of friends and family.

She was diagnosed to have thrombosis of the ocular vein in 1985, leaving her blind in the right eye, whereas at the same time she suf­fered from glaucoma involving her left eye, which was treated with daily hemodialysis treat­ments. She had a mild peripheral neuropathy involving her feet and a right carpal tunnel syn­drome in 2004.

She was noted to have ischemic heart disease, which required angioplasty (PTCA) of her left anterior descending artery in 2006. She suffered from supraventricular tachycardia in 2006 and, over the subsequent three years, she had inter­mittent problems with paroxysmal atrial fibril­lation that required medication. She was found to have mild aortic and mitral valve stenosis, secondary to valve calcification and pulmonary hypertension. She neither smoked nor drank alcohol.

After 26 years of hemodialysis, the side-effects of long-term hemodialysis, especially renal osteo-dystrophy, had greatly limited her mobility. She underwent surgery for parathyroidectomy in 1994, but her PTH levels gradually increased up to 7055 pg/mL. Her bones were weak and eroded. She fell and fractured her pelvis in 1990, which was followed by fractured fingers (two fingers of her left hand) in January 2002. She was walking with a cane due to chronic back pain, and otherwise relied on the help of others in order to take a few steps. In the up­coming years, she was successfully treated with cinacalcet, whereas treatment with Vitamin D analogous was not considered an option due to high calcium blood levels. Nevertheless, she felt well despite the fact that thrice-weekly hemodialysis remained uneventful.

She was determined to live and fought for this. She raised her children and celebrated together with her husband their marriage, which has always been her wish to experience. And, later on, she became a grandmother. Although phy­sically limited, she was active mentally and socially and visited her grandchildren as much as possible.

She died on 17 April 2009 after 30 years on hemodialysis. She suffered many burdens of the long term hemodialysis: Bone disease, amyloidosis, muscle loss and heart valve stenosis. The changes she had seen in hemodialysis therapy were revolutionary. Some of the improvements she had witnessed over the years included the arteriovenous fistula, bicarbonate dialysate, hol­low fiber dialyzers, volumetric control and erythropoietin. It is now established that dialysis can keep chronic renal failure patients alive for many years, even decades in the case of younger patients who are free of other systemic diseases.


   Discussion Top


The obvious benefit of hemodialysis is conti­nuing life itself. Of course, there is still no per­fect substitute for a real kidney. The replacement of the Scribner shunt [3] by the arteriovenous fis­tulas was an important improvement. [4] The use of erythropoietin to correct anemia in dialysis patients and exercise tolerance is well recognized. [5] The reduction in treatment duration to 4 h, in tandem with high-flux dialysis that fol­lowed, represents a definite improvement.

A condition called beta 2 -microgobulin amyloidosis is a serious problem for nearly all patients who have been on dialysis for more than a decade. [6] Despite adequate dialysis dose and protein intake, patients treated with hemodialysis for a long period of time become malnourished. [7],[8],[9]

Most of the problems the patient experiences are of a psychological nature, as many patients have difficulty in adapting to the idea that their lives are dependent on a mechanical apparatus.

Information about patients who have been on long-term hemodialysis is scarce because there is no registry of extremely long-lived hemodialysis patients. [4] On review of patients, a few details pop out. There are no older patients or diabetics. Whether this is because the selection process many years ago was biased against older patients or diabetics, or whether these pa­tients generally do not do as well on hemodialysis, is not clear. The majority of long-lived hemodialysis patients had a long-lived dialysis access, which is helpful, compared with arteriovenous grafts or hemodialysis catheters. Renal osteodystrophy presented despite treatment with parathyroidectomy prior to the use of cinacalcet and vitamin D analogous. Dialysis-related amyloidosis has also caused significant disability, whereas high-flux dialyzers reduced the rate of appearance. [4],[10]

It is important from a number of perspectives to be aware of these long-term survivors. It is important from a historical perspective and in order to appreciate that at least a small number of patients could live through relatively pri­mitive equipment and function for an extended period of time.

Conflict of Interest: None

 
   References Top

1.Scribner BH, Buri R, Caner JE, Hegstrom R, Burnell JM. The treatment of chronic uremia by means of intermittent hemodialysis: A preli­minary report. Trans Am Soc Artif Intern Organs 1960;6:114-22.  Back to cited text no. 1
[PUBMED]    
2.Konert J, Pauer HD, Schabel J, Anger G. Thirty years of hemodialysis treatment at Martin Luther University in Halle-Wittenberg. Z Exp Chir Transplant Kunstliche Organe 1990;23:73-5.  Back to cited text no. 2
    
3.Kerr ND. Twenty five years of hemodialysis. A tribute to the pioneer work of Belfast Unit. Ulster Med J 1985;54:S86-99.  Back to cited text no. 3
    
4.Rifkin IS. Thirty-Seven Uninterrupted Years of Hemodialysis: A Case Report. Medscape J Med 2008;10:231.  Back to cited text no. 4
    
5.Mocks J. Cardiovascular mortality in hemo-dialysis patients treated with epoetin beta-a retrospective study. Nephron 2000;86:455-62.  Back to cited text no. 5
    
6.Otsubo S, Kimata N, Okutsu I, et al. Charac­teristics of dialysis-related amyloidosis in patients on hemodialysis therapy for more than 30 years. Nephrol Dial Transplant 2009;24: 1593-8.  Back to cited text no. 6
    
7.Kopple DJ, Massry GS. Kopple and Massry's nutritional management of renal disease. 2 nd ed. Philadelphia: Lippincott Williams & Wilkins; 2004.  Back to cited text no. 7
    
8.Chazot C, Laurent G, Charra B, et al. Malnu­trition in long-term hemodialysis survivors. Nephrol Dial Transplant 2001;16:61-9.  Back to cited text no. 8
    
9.Ikizler TA, Wingard RL, Sun M, Harvell J, Parker RA, Hakim RM. Increased energy expenditure in hemodialysis patients. J Am Soc Nephrol 1996;7:2646-53.  Back to cited text no. 9
    
10.Otsubo S, Otsubo K, Sugimoto H, et al. Charac­teristics of patients on hemodialysis therapy for more than 30 years. Ther Apher Dial 2007;11: 274-9.  Back to cited text no. 10
    

Top
Correspondence Address:
Dr. Konstantina Triga
Kyanous Stavros Patron Dialysis Unit, Patras, Greece

Login to access the Email id


DOI: 10.4103/1319-2442.139939

PMID: 25193907

Rights and Permissions




 

Top
   
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
   Introduction
   Case Report
   Discussion
    References
 

 Article Access Statistics
    Viewed1481    
    Printed26    
    Emailed0    
    PDF Downloaded304    
    Comments [Add]    

Recommend this journal