Objectives 4-year dialysis freedom with improved wellbeing has been reported in end-stage renal disease (ESRD) using a new therapeutic approach combining conservative measures and acacia gum (AG) supplementation.1 The aim of this paper is to report the achievement of 6 year dialysis freedom.

Methods During December 2001, six patients with ESRD were enrolled in a clinical trial investigating the use of a new therapeutic approach combining conservative measures and AG supplementation, aiming at improving wellbeing and providing patients with ESRD dialysis freedom.2 Three patients were treated with the new therapy. One patient complied with protocol for only 10 days and died after 6 months despite intermittent peritoneal dialysis (IPD). Two patients completed one year. Both patients maintained serum creatinine and urea levels not previously achieved without dialysis. The other three patients were managed with IPD, and all died within less than 6 months. Of the 2 surviving patients on AG supplementation, one patient stopped AG supplementation after one year and died within one month despite IPD. The other patient continued to be treated with this novel therapy and continued to experience improved wellbeing and dialysis freedom during 4 years.

Results During 6 years of therapy the girl continued in experiencing improved wellbeing and good participation in outdoor activities. Mild uremic symptoms occurred only during periods of non-compliance. Periods of decreased compliance with pharmacologic therapies were associated with anemia and renal osteodystrophy and some degree of genue vulgum has resulted.

Conclusions 6 year dialysis freedom is achievable in ESRD.