A Patient with Ultrafiltration Failure

Dr. S.M. Korbet: The patient is a 32-year-old black male who developed end-stage renal disease at the age of26, secondary to glomerulonephritis. He had a history of hypertension since the age of 19, and had been known to be an intravenous drug abuser for at least ten years. In May 1985, he was started on peritoneal dialysis (PD) when his BUN was found to be lOO mg/dL (35.7 mmol/L), with a serum creatinine of14.8 mg/dL (1308 μmol/L). At the time dialysis was started, a 24-hour urine demonstrated a creatinine clearance of 8 mL/min. A week after starting peritoneal dialysis he was found to have swelling in the right inguinal area and subsequently underwent a right inguinal herniorrhaphy. Peritoneal dialysis was restarted without further complications. He was initially placed on continuous ambulatory peritoneal dialysis (CAPD) using 2-L volumes with three exchanges ofl.5 % during the day and a4.25 % exchange overnight. His medications consisted of multivitamins, calcitriol 0.25 μg daily, captopril10 mg b.i.d., aluminum hydroxide 30 mL orally with meals, and lactulose 30 mL as needed. Over the first six months on dialysis the patient's weight vacillated between 184 (83.6 kg) and 194 lb (88.2 kg). As a result, his blood pressure was difficult to control but very sens