A CASE OF GLIOBLASTOMA IN A PERITONEAL DIALYSIS PATIENT

 

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A CASE OF GLIOBLASTOMA IN A PERITONEAL DIALYSIS PATIENT

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Keiichi
Osano
Keiichi Osano kosano@yamanashi.ac.jp Graduate School of Medicine, University of Yamanashi Department of Nephrology Chuo, Yamanashi Japan *
Natsumi Saegusa saenatsumi@yamanashi.ac.jp Graduate School of Medicine, University of Yamanashi Department of Nephrology Chuo, Yamanashi Japan -
Kie Ohkoshi kieo@yamanashi.ac.jp Graduate School of Medicine, University of Yamanashi Department of Nephrology Chuo, Yamanashi Japan -
Shun Yoshida yoshidas@yamanashi.ac.jp Graduate School of Medicine, University of Yamanashi Department of Nephrology Chuo, Yamanashi Japan -
Makiko Konishi makikok@yamanashi.ac.jp Graduate School of Medicine, University of Yamanashi Department of Nephrology Chuo, Yamanashi Japan -
Ayumu Nakashima a.nakashima@yamanashi.ac.jp Graduate School of Medicine, University of Yamanashi Department of Nephrology Chuo, Yamanashi Japan -
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A 68-year-old man with chronic renal failure due to diabetic nephropathy underwent peritoneal dialysis (PD) catheter insertion in January, Year X, and initiated PD on March 5. Within several days, he mastered the PD technique independently, was discharged, returned to work, and initially maintained a good quality of life.

However, in early April, he developed listlessness, cognitive decline, and increasing dependence, spending most of the day bedridden. On April 18, as his level of consciousness deteriorated and he was unable to eat, he was brought for an emergency evaluation by his family. Computed tomography of the head revealed a tumorous lesion with extensive severe edema in the left frontal lobe. He was admitted the same day, continued PD with full nursing assistance, and subsequently underwent complete resection of the brain tumor on May 2.

Histopathology confirmed glioblastoma (IDH-wild type). From May 26 to July 6, the patient received radiotherapy (60 Gy/30 fractions) combined with temozolomide (140 mg/body; standard dose). No significant treatment-related adverse events occurred. His impaired consciousness gradually improved, and he regained the ability to eat independently. Although motor aphasia and right hemiplegia persisted, he was able to use a wheelchair with assistance. He was transferred to a local hospital for rehabilitation, where maintenance therapy with temozolomide was continued. During this time, PD was performed with the assistance of nurses and caregivers, allowing him to live peacefully until April, Year X+2.

The 5-year survival rate of glioblastoma patients diagnosed in their 60s is 4.7%, representing the poorest prognosis among brain tumors and curative treatment is extremely difficult. According to classification by recursive partitioning analysis (RPA), this case corresponds to the most severe Class V, associated with a median survival of 7.5 months. However, the patient survived for 24 months after onset, suggesting a degree of therapeutic efficacy. While several reports describe glioblastoma treatment in hemodialysis patients, only one prior case report has documented glioblastoma treatment in a PD patient. Therefore, this case represents a valuable contribution, and we report its clinical course.

Kewords