Thirty years on hemodialysis: One patient's story

The prognosis for patients starting dialysis continues to improve with adva nces in medical technology and a greater understanding of the pathological processes that accompany end-stage renal failure. At the time when chronic dialysis facilities were first being set up more than 30 years ago, the out look for patients entering such programs was far less optimistic. Mortality rates, even for young patients, were high, and only with the development o f transplant programs did there appear to be any cause for optimism that lo ng-term survival could be achieved. Most patients who survive end-stage ren al failure for more than 15 years are likely to have their history interrup ted with at least one transplant and, possibly, the use of different forms of dialysis, both peritoneal and hemodialysis. However, with the greater re cognition of the problems of atherosclerosis, cardiovascular disease, anemi a, renal osteodystrophy, and dialysis-related problems, as well as the targ eting of specific strategies toward these processes, it has become evident that long-term survival on dialysis, with good qualify of life, is a realis tic goal. We represent a man who has survived more than 30 years on hemodia lysis, and who has never had a successful renal transplant or used any othe r form of renal replacement therapy. He now has all of the complications of prolonged chronic renal failure, but he has witnessed and has become apart of, the history of modern renal replacement therapy as one of the longest, if not the longest, surviving patients in Europe on uninterrupted hemodial ysis.