A patient with chronic glomerulonephritis and terminal renal failure was kept alive for nine months by 33 hemodialyses and five peritoneal dialyses. Although established criteria for selection of patients for periodic dialysis were met, complications were numerous and, finally, lethal. Nutritional failure, hypertension, congestive heart failure, arthritis, infections, and arteriovenous shunt failures all contributed to the patient's inexorable deterioration. Careful salt and water restriction, and then bilateral nephrectomy, failed to arrest the progressive hypertension. The patient's course stresses the need for careful medical selection of candidates for periodic dialysis, and also illustrates that such a program may be unsuccessful even when rigid criteria are used.
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Bunn et al. (1964) studied this question.
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