Objective: To describe a new model for the management of end-stage renal failure (ESRF) associated with longest period of dialysis freedom (4-year) achieved with this novel form of renal replacement therapy (RRT).The research was done in accordance with Helsinki declaration and approved the scientific committee in the hospital. Conservative management of chronic renal failure (CRF) can only be successful in nonterminal CRF, and patients with ESRF cannot sustain life in the absence of renal replacement therapy. A new regimen combining the traditional conservative management of CRF (dietary and pharmacologic) with addition of Acacia gum (AG) 1 g kg(-1) per day has been reported to provide patients with ESRF dialysis freedom. An 11-year-old girl with ESRF initially required four sessions of intermittent peritoneal dialysis to control uremic symptoms despite conservative measures. The parents refused further treatment by dialysis. Thereafter, she was managed with a new regimen combining the traditional conservative management of CRF with addition of AG. Four year dialysis and improved well-being was achieved. The chronicity of her illness was confirmed by the presence of small contracted kidneys, a finding that has not changed during the subsequent follow-up. During these 4 years she continued experiencing improved well-being and good participation in outdoor activities, had never been acidotic or experienced significant uremic symptoms.
Conclusion: This is the longest period of dialysis freedom reported in children with ESRF.