Home haemodialysis with a novel machine in a patient with end-stage kidney disease: first case report from Asia

摘要

The patient is a 38-year-old man who previously worked as a computer programmer and currently resides in Hong Kong with his parents and his younger brother in a flat of around 500 square feet. At age 22, he was diagnosed with diabetes mellitus subsequently complicated by diabetic nephrosclerosis and non–vision-threatening retinopathy. His comorbidity includes overweight, hypertension, hypothyroidism, and eczema. He developed end-stage kidney disease (ESKD) in late 2015 and commenced peritoneal dialysis (PD) that unfortunately failed after 3 years due to refractory PD-related peritonitis. Thereafter, he commenced in-centre haemodialysis (HD) in 2018. The patient underwent 4 hours of in-centre HD 3 times per week via his left forearm arteriovenous fistula. He subsequently reported increased lethargy with poor appetite and was mainly sedentary after quitting his job. His daily fluid intake fluctuated widely with interdialytic weight gain up to 4 to 6 kg necessitating an increase in his antihypertensive medications. His appetite remained suboptimal, and his dry body weight gradually decreased from 72 kg (height: 1.72 m, body mass index: 24.3) at the start of in-centre HD in late 2018 to 67 kg (body mass index: 22.6) by late 2020. He also experienced a worsening of uremic pruritus. Cannulation for dialysis became increasingly difficult due to his eczema. His standardised Kt/V value averaged 1.4 only. His medications are shown in Table 1.