LAUSR

diately before the start of HD combined with saline flushes during the session. Normal saline flushes without heparin were applied only after intracranial bleeding due to tumor necrosis (June and September 2015). At that time citrate anticoagulation for HD was not available in our center, and patient's family refused peritoneal dialysis. By adjustment of HD protocol we maintained patient's pre-HD BUN 11.9-13.8 mmol/L and 7.7-9.7 mmol/L at the end of HD session (less osmotic shifts per session), leukocytes 10.2 × 10/L, erythrocytes 3.55 × 10/L, hemoglobin 109 g/L, hematocrit 0.378, thrombcytes 175 × 10/L. Anemia was treated with intravenous erythropoietin and iron. The second MRI (May 2015) showed reduction of BE (Figure 1B). In June 2015 MRI confirmed progression of tumor infiltration and necrosis without worsening of BE (Figure 1C). The last MRI (October 2015) illustrated a new lesion on the contralateral side and progression of tumor infiltration with mild perifocal vasogenic edema (Figure 1D). The rapid spread of the tumor deteriorated patient's quality of life; patient became immobilized (right-sided hemiparesis and paresis of the left arm), with epileptic seizures and global aphasia. Patient died 11 months since the diagnosis was confirmed. This is the first case of glioblastoma cerebri in hemodialyzed patient and emphasizes the importance of hemodialysis protocol adjustment for reaching the same survival as patients with same diagnosis, but without hemodialysis.