Nocturnal home hemodialysis for a patient with type 1 hyperoxaluria.

[primary hyperoxaluria type 1]

Type 1 primary hyperoxaluria is a genetic disorder caused by deficiency of the liver -specific peroxisomal enzyme alanine-glyoxylate aminotransferase . This enzyme deficiency leads to excess oxalate production and deposition of calcium oxalate salts , resulting in kidney failure and systemic oxalosis . Aside from combined liver /kidney transplantation , no curative treatment exists . Various strategies for optimizing dialysis treatment have been evaluated , but neither conventional hemodialysis nor peritoneal dialysis can keep pace with oxalate production in this patient population . In this report , we describe a patient with end-stage renal disease from type 1 primary hyperoxaluria managed with nocturnal home hemodialysis . Performing hemodialysis 8 -10 hours each night with blood flow of 350 mL /min and total dialysate volume of 60 L , she has maintained pre- and postdialysis serum oxalate levels at or below the level of supersaturation . We also review published literature regarding oxalate removal in various modalities of dialysis in patients with type 1 primary hyperoxaluria . In our patient , nocturnal hemodialysis has controlled serum oxalate levels better than conventional hemodialysis therapies . Home nocturnal hemodialysis should be considered an option for management of patients with end-stage renal disease from type 1 hyperoxaluria who are awaiting transplantation .