title: [Long term survival patient on hemodialysis--case report].
abstract: OBJECTIVE
  The mortality of chronic kidney disease patients is very high. Patients on chronic renal replacement therapy are also et very high mortality risk. Nevertheless, by the advance in renal replacement therapy the surveillance of these patients could be long with reasonable quality of life. The present a patient on renal replacement therapy for more than 38 years.
  
  
  METHODS
  Our patient was born in 1946. Twenty years later acute glomerulonephritis was diagnosed and he was treated with corticosteroid therapy for four years. Despite treatment his renal function deteriorated and haemodialysis was started in 1974. At that time, the haemodialysis regime was 12 hours two time per week and Kill dialyzer were used. Bicarbonate dialysis was introduced in 1984. Last 15 years our patient is on the hemodiafiltration. The treatment by erythropoietin was started in 1993. During this 38 years, he received two cadaveric kidney transplants. The first transplantation was in December 1974 in our hospital. Few days after transplantation he get rejection and transplant kidney never functioned. After one month he get thrombosis of the graft and transplantectomy was performed. The second cadaveric transplantation was performed abroad in 1985. Transplant kidney functioned only four days and fifth days urgent transplantectomy was performed. After these experience our patient decline any new kidney transplantation. First arteriovenous fistula was created at the time of start haemodialysis and was functional for 30 years. First arteriovenous graft was created after 30 years on the left forearm few years later on the left upper arm. Last graft has been in good function for six years. The last two years he has a central venous catheter. A subtotal parathyroidectomy was performed in 1983. After parathyroidectomy parathyroid hormone values were between 30 to 55 pmol/L, and the values of serum calcium and serum phosphate were in reference values. Last 15 years he had bone pain and before 10 years he had patlogical hip fracture. Due to vascular disease he often had skin ulcers and infections, particularly on the both hands. Very often he was treated by analgetics, sedatives, including opiates. Last severe complications was a bowel perforation, successfully treated by surgical intervention.
  Our patient graduated on the university. He is married and had one child. He has worked in the profession for several years. He was founder of association for dialysis and kidney transplant patients. Last twenty years he and colleagues conducted a private centre for haemodialysis. It was the first private centre in the country.
  
  
  CONCLUSIONS
  Dialysis treatment sometimes can significantly prolong life, i.e. far more than expected in this group of patients and can offer appreciable quality of life.
authors.affiliation: Department of Nephrology and Dialysis, University Hospital Rijeka, Rijeka, Croatia. lidija.orlic@ri.t-com.hr
authors.forename: Lidija
authors.initials: L
authors.lastname: Orlić
authors.forename: Branka
authors.initials: B
authors.lastname: Sladoje-Martinović
authors.forename: Stela-Zivcić
authors.initials: SZ
authors.lastname: Cosić
authors.forename: Ivica
authors.initials: I
authors.lastname: Maleta
authors.forename: Sretenka
authors.initials: S
authors.lastname: Vuksanović-Mikulicić
authors.forename: Ivan
authors.initials: I
authors.lastname: Bubić
authors.forename: Martina
authors.initials: M
authors.lastname: Pavletić-Persić
authors.forename: Sanjin
authors.initials: S
authors.lastname: Racki
mesh_terms: D000368:Aged; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis; D017741:Survivors