title: Six-year dialysis freedom in end-stage renal disease.
abstract: BACKGROUND
  Patients with end-stage renal disease (ESRD) cannot sustain life in the absence of renal replacement therapy (RRT). However, a 4-year dialysis freedom with improved well-being has been reported in ESRD using a new therapeutic approach combining conservative measures and acacia gum (AG) supplementation. The aim of this paper is to report the achievement of 6-year dialysis freedom.
  
  
  METHODS
  During December 2001, six patients with ESRD and significant uremia that required at least one dialysis session to maintain life were enrolled in a clinical trial investigating the use of a new therapeutic approach combining conservative measures and AG supplementation aiming at improving well-being and providing patients with ESRD dialysis freedom. Three patients were treated with this approach. One patient complied with protocol for only 10 days and died after 6 months peritoneal dialysis. Two patients completed 1 year on this therapeutic regimen. Both patients reported improved well-being. Neither became acidotic nor uremic, and neither required dialysis during the 1 year of the study period. Both patients maintained serum creatinine and urea levels not previously achieved without dialysis. The other three patients were managed with intermittent peritoneal dialysis (IPD). All died within less than 6 months. Of the two surviving patients on AG supplementation, one patient stopped AG supplementation after 1 year and died within 1 month despite IPD. The other patient continued to be treated with this novel approach and continued to experience improved well-being and dialysis freedom. The aim of this paper is to report the achievement of 6-year dialysis freedom in this patient.
  
  
  RESULTS
  During 6 years of therapy the girl continued in experiencing improved well-being and good participation in outdoor activities. Mild uremic symptoms occurred only during periods of noncompliance. Periods of decreased compliance with pharmacologic therapies were associated with anemia and renal osteodystrophy and some degree genue vulgum has resulted.
  
  
  CONCLUSIONS
  It was possible to address ESRD in this particular patient as a disease process that can be treated by totally different medical treatment approaches without the use of either chronic dialysis or transplant.
authors.affiliation: Department of Pediatrics, University Hospital in Al Kadhimiyia, PO Box 70025, Baghdad, Iraq. almosawiAJ@yahoo.com.
authors.forename: Aamir Jalal
authors.initials: AJ
authors.lastname: Al Mosawi
mesh_terms: D019587:Dietary Supplements; D005260:Female; D006170:Gum Arabic / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010349:Patient Compliance; D010530:Peritoneal Dialysis; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D006170:Gum Arabic