The patient is 77 year old man with initiation of HD Via perm cathter since July 6 because of bil.atrophic kidney and bun206,cr17.6a/g3.5/2.5,k5.4,ca8.7p5.4,hct17.5. He tolerated shorterm of 3.5hr of HD course untill July 26.He developed sudden cardiac arrest with 160ml of BF of perm cathter within 5 minutes on July 26 and August 7 (hct 25%).

He developed frequently hypotensive episodes (sbp 100mmhg from 130-150 at home) and bradycardia (48-58/min from 64 at home) within 5 minutes and tolerated hd course after salin 100ml flushing and increased hct to 31% with pack RBC. He had small pericardial effusion and 2000ml lt pleural effsion after drainaged. Heart echo showed LVEDD75.6mm,LVEF49% and mild AR,mod.MR and TR,Pul.hypertension.

X-ray showed cardiomegaly with 0.6 C-T ratio. He had mild fever on August .20 a nd no chest tightness or sob. He complained of postdialytic hoarseness and tinnitus with bw 49kgs.He just took folic and multivitamin. We will appreciate your expertise for the reason of this patient and how to treat. Thanks.