Patients with end-stage kidney disease, who require hemodialysis for more than three months, have little chance of terminating dialysis. The purpose of this case report is to show the effects of patient kidney care and nutrition on the termination of dialysis and patient follow-up. We present a 74-year-old end-stage kidney disease patient who underwent hemodialysis 3 times a week for 7 years. After the patient underwent a special kidney care and nutrition program called Toprak's Kidney Care, hemodialysis was terminated by gradually reducing the dialysis sessions over 2.5 months. During the 62-month follow-up after discontinuing dialysis, the patient required no kidney replacement therapy. The glomerular filtration rates were stable at 8-10 mL/min/1.73 m2. During the follow-up period, the patient was not hospitalized and no major adverse cardiac events occurred. To date, the patient remains in good health. Toprak’s Kidney Care and nutritional support may be considered during the termination of HD in ESKD patients. The discontinuation of HD in ESKD patients who have adequate urine output may be considered, even after 7 years of HD. Consensus and clinical guidelines regarding the termination of chronic HD in ESKD patients are needed

End-stage kidney disease patients who require hemodialysis for more than 3 months have a small chance of leaving dialysis unless they have a kidney transplant. Educating the patient about lifestyle changes can play a major role in improving kidney function. Therefore, we created a patient education program according to our nephrology experiences. Herein, we show an end-stage kidney disease patient who underwent hemodialysis for 6 months. Afterwards, dialysis was terminated with patient care, and the patient was then followed up for 9 years without dialysis. To date, there have been no reports regarding the termination of long-term dialysis with a kidney care program and the ensuing 9-year follow-up without renal replacement therapy.

Patient: Male, 77-year-old Final Diagnosis: End-stage renal failure Symptoms: No symptoms Medication:— Clinical Procedure: — Specialty: Nephrology Objective: Unusual clinical course Background: End-stage kidney disease patients who need hemodialysis for more than 3 months are less likely to be able to discontinue dialysis. Patient care, however, can play a role in improving kidney function. In this study, we showed that even a patient on hemodialysis for 8 years can discontinue or reduce the number of weekly dialysis sessions through kidney care. Here, we report the effect of patient care on the ability to cease dialysis or reduce dialysis sessions, discuss such cessation or reduction in chronic hemodialysis patients, and describe proper follow-up procedure for a patient whose dialysis has been discontinued or reduced. Case Report: Here, we present a 77-year-old man who had undergone hemodialysis 3 times weekly for 75 months, after which dialysis sessions were gradually decreased and terminated within 21 months while undergoing Toprak’s Kidney Care, a kidney care program. The patient went without dialysis for 10 months. Then, hemodialysis was started once weekly for 46 months, as the glomerular filtration rate values decreased significantly. Following this period, he underwent hemodialysis 3 times weekly for 19 months. During these follow-up periods, 2 hospitalizations were required due to pneumonia and atrial fibrillation. There were no major adverse cardiac events. The patient is still in our follow-up care. Conclusions: Gradual termination of an 8-year period of hemodialysis through a kidney care program without kidney transplantation is very rare. In end-stage kidney disease patients with adequate urination, kidney care should be considered to terminate hemodialysis or reduce the weekly dialysis sessions.

B, Ucdu GZ. Dialysis-requiring acute kidney injury and electrolyte imbalances as a result of prodromal herpes zoster in a kidney transplant recipient. Transpl Infect Dis.

Diabetes Mellitus is a globally common, chronic metabolic disease. In progression of disease itself, peripheral insülin resistance and insülin secretion disorders can be observed. In addition there can be electrolyte disorders such as magnesium, calcium and iron deficiency. Magnesium levels may have significant role in the clinical course of the disease. In this study, it is aimed to observe relationship among magnesium levels glucose regulation and proteinuria. In this cross sectional study, 200 diabetic patients were examined for magnesium levels. Blood parameters and proteinuria levels were determined and the patients were divided into two groups as hypomagnesemic and normomagnesemic. Glucose levels, HbA1c and proteinuria levels were compared between groups. Of the cases (n=200), 59 (29.5 %) were male and 141 (70.5 %) were female. The frequency of hypomagnesemia was 38.5 %. The incidence of hypomagnesemia in women (46.1 %) was significantly higher than in men (20.3 %) (p=0.001). In hypomagnesemia group, glucose level (179.7 ± 60.2 mg/dL) was higher than normomagnesemia group (160.7 ± 52 mg/dL) (p=0.013). However, no statistically significant difference was observed between the groups in terms of HbA1c level. Proteinuria levels were higher in hypomagnesemia group (0.18 ±0.12 mg/mg) than normomagnesemia group (0.14±0.05 mg/mg) (p=0.013). Magnesium deficiency is a common condition in diabetic patiens and may have negative effects on glucose regulation and proteinuria. Randomized controlled trials are needed to clarify the role of magnesium in diabetic complications.