Long-term-treatment of a diabetic nephropathy-case exclusively with hemofiltration

There have been numerous reports of short-term follow ups in hemofiltration (HF), but only a few have reported on long-term ones. The purpose of this article is to report the case of an old man who has been undergoing HF for about 26 months after 2 years of hemodialysis (HD), and the phenomenon of an abrupt decrease in the blood glucose level during HF. The 67-year-old man with diabetes mellitus (DM) was admitted to our hospital due to chronic renal failure, diabetic retinopathy and neuropathy. He had been suffering from DM and treated with insulin for 25 years. The laboratory data showed BUN, 106mg/dl and s-Cr, 6.6mg/dl, indicating end-stage renal disease. After being hospitalized for 6 weeks he received HD, but we found it difficult to control his hypotension during HD with acetate dialysate and even with high sodium or bicarbonate dialysate. Therefore, we transfered him from HD to HF (Sartorius, Hemoprocessor-Hemofilter; Simizu, HF Solita®). Immediately after the transfer to HF, the frequency and severity of hypotension decreased markedly. In addition there were no serious side-effects of the HF during about 26 months of treatment, except a slight increase in the s-Cr level. There was an abrupt decrease in the blood glucose level during HF. This proved to be due to the fact that the substitution fluid contained no glucose. It is well known that in DM the sharp fluctuations in the blood glucose level aggravate diabetic complications. The addition of glucose to the substitution fluid induced a slight and smooth change in the blood glucose level during HF similar to that of a non-HF day. Therefore it is very important with HF to use a substitution fluid containing glucose. This case demonstrates that HF is very effective in cases having hypotensive tendencies during HD, that HF probably does not cause any remarkable side-effects when used over a long period, and that it is very important to perform HF with a glucose-containing substitution fluid, particularly in DM in view of the progression of diabetic complications.