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More than 17 years of peritoneal dialysis: a case report
1Service de Néphrologie-hémodialyse, Hôpital Henri Duffaut, Avignon, France.
Insights
This case study highlights a patient on peritoneal dialysis (PD) for over 17 years. Key factors for her successful long-term PD include a healthy peritoneal membrane and absence of infections.
Area of Science:
- Nephrology and Dialysis
- Renal Medicine
- Chronic Kidney Disease Management
Background:
- Peritoneal dialysis (PD) is a renal replacement therapy for end-stage renal disease.
- Long-term data on PD patient outcomes, especially in small-bodied individuals with severe vascular nephropathy, are limited.
- This report details a unique case of extended PD therapy initiated due to patient refusal of hemodialysis.
Observation:
- A 50-year-old female patient with malignant hypertension and renal failure initiated intermittent PD (IPD) in 1979, later transitioning to continuous ambulatory PD (CAPD).
- Despite developing complications like renal osteodystrophy and hyperparathyroidism, she maintained CAPD for over 17 years with the same Tenckhoff catheter.
- She experienced no peritonitis or exit-site infections, utilized acetate and lactate dialysis solutions, and maintained satisfactory dialysis adequacy and nutritional status.
Findings:
- The patient demonstrated sustained dialysis adequacy (weekly Kt/V: 2.15) and good nutritional parameters despite significant weight loss and anuria for over 11 years.
- Her peritoneal membrane permeability was classified as high-average, contributing to effective dialysis.
- She maintained a good quality of life throughout the 17-year PD treatment period.
Implications:
- Factors contributing to successful long-term PD include small body size, absence of infections, a healthy peritoneal membrane, patient acceptance, and diligent dietary management.
- This case underscores the potential for achieving adequate dialysis and maintaining quality of life with PD even in complex patient profiles.
- Vigilance in managing potential complications and optimizing dialysis parameters is crucial for long-term PD success.
Abstract:
Very few patients have undergone long-term peritoneal dialysis (PD). We report a case of a female patient on PD since 26 May 1979. Suffering from malignant hypertension, she developed renal failure in April 1979. The renal biopsy showed a severe vascular nephropathy. She was 50 years old, her body weight (BW) was 45 kg, and her height was 1.49 m. She refused hemodialysis. A Tenckhoff catheter was installed, and 12-hour intermittent PD (IPD), three times a week, was started in the dialysis center. Ten months later, she began nightly home IPD. In March 1985 she started continuous ambulatory PD (CAPD); she was nearly anuric. During the following years, she developed renal osteodystrophy and suffered from repeated hyperparathyroidism requiring multiple surgical interventions, osteomalacia, pseudotumoral calcinosis, and, finally, adynamic bone disease. She is now 67.5 years old, her BW is 34 kg, and she is still using CAPD. This patient has the same Tenckhoff catheter. She never developed peritonitis or an exit-site or tunnel infection. She used acetate dialysis solution for nearly six years and then lactate solution. Presently her peritoneal permeability is of the high-average type; dialysis adequacy (weekly Kt/V: 2.15, weekly peritoneal clearance: 58 L/1.73 m2) as well as nutritional parameters are satisfactory. She has moderate anemia without erythropoietin treatment. She maintains a good quality of life. Although the patient lost 11 kg in 17 years, she has maintained good nutritional status. Dialysis adequacy could be achieved despite anuria for more than 11 years. Small body size, absence of infection and catheter-related problems, healthy peritoneal membrane, good acceptance of the technique, and vigilance towards dietary habits may be the keys for satisfactory long-term PD.