Intestinal dialysis in a uremic patient with diabetic nephropathy: A challenging case and a unique experience

Abstract

Background: The beneficial use of intestinal (dietary) dialysis in patients with chronic renal failure has been increasingly described during the previous two decades. The cornerstone of the dietary management during intestinal dialysis is protein restriction that is compensated by adequate caloric intake. On the other hand the dietary management of diabetic patients includes calorie restriction that is compensated by adequate intake of proteins. Therefore, the dietary prescription of intestinal dialysis in diabetic patients can be challenging and are not expected to be convenient for many patients. However, a beneficial effect of intestinal in a patient with insulin dependent diabetes mellitus and symptomatic uremia has been reported. The aim of this paper is report a beneficial effect of intestinal dialysis in a diabetic uremic patient who had insulin dependent diabetes mellitus. Patients and methods: A 28-year-old female patient with insulin dependent diabetes mellitus, and symptomatic uremia and refused treatment with dialysis. She had marked weakness and was unable to stand and walk unaided. However, she didn’t have a life threatening uremic complication such as gastrointestinal bleeding or encephalopathy on referral. The patient was treated with intestinal dialysis. Results: The patient experienced amelioration of symptoms of uremia with improved general wellbeing in association with lowering of urea levels and creatinine during the period of therapy. She was unable to stand and walk unaided before the start of therapy, but she was able to climb more than 10 steps upstairs unaided after three weeks of therapy.