Fatigue disappearance in hemodialysis patients by dual approach with hydrogen gas inhalation and hydrogen-enriched dialysate: two case reports
Nakazawa R, Nagami S, Nozaki H, Yataka M, Akiyama K, Uchino T, Azuma N. · Medical Gas Research. 2025;15(1):59–61.
Study at a glance
Human
Two men aged 64 and 53 years undergoing long-term hemodialysis/hemodiafiltration with severe post-dialysis fatigue.
Existing electrolyzed-water online hemodiafiltration using H₂-enriched dialysate plus pure H₂ by nasal cannula throughout dialysis, three times weekly for three months. · Dialysate averaged 300 ppb dissolved H₂. The generator supplied 99.99% H₂ at 250 mL/min; the article describes an estimated inhaled concentration of 2.5%.
Four to five hours per dialysis session, three sessions weekly, for three months.
Both patients' reported fatigue and EQ-VAS improved during combined therapy and worsened again after return to conventional dialysis; several biomarkers changed in the reported favorable direction. The design cannot separate H₂ inhalation from H₂ dialysate, order, expectation or other time effects.
Only two unblinded cases, subjective outcomes, combined intervention, no concurrent control and extensive previous exposure to H₂ dialysate. The report names commercial dialysate and H₂-generator products; no explicit funding or conflict statement was identified, so their absence is not inferred.
What kind of evidence is this?
Human
Two-patient uncontrolled before/after case report with treatment withdrawal observations
Kidney and urinary health
Inhaled H₂
Information not yet classified
Some editorial classification fields are still pending. The source-reported outcomes and result are shown below; Hydrogenology does not infer a positive or negative signal from prose automatically.
Methods
Two men aged 64 and 53 years undergoing long-term hemodialysis/hemodiafiltration with severe post-dialysis fatigue.
Two patients treated at one clinic; there was no randomized or concurrent control group.
Four to five hours per dialysis session, three sessions weekly, for three months.
Existing electrolyzed-water online hemodiafiltration using H₂-enriched dialysate plus pure H₂ by nasal cannula throughout dialysis, three times weekly for three months.
Two H₂-only routes: dissolved H₂ in dialysate and nasal-cannula H₂ gas — not Brown's gas; no O₂ was generated or supplied with the H₂ stream.
Dialysate averaged 300 ppb dissolved H₂. The generator supplied 99.99% H₂ at 250 mL/min; the article describes an estimated inhaled concentration of 2.5%.
250 mL/min H₂ from the nasal-cannula generator for each 4–5-hour dialysis session.
No supplemental O₂ was co-delivered; ambient-air breathing/entrainment was not quantified.
Within-person periods of conventional hemodiafiltration and electrolyzed-water hemodiafiltration without gas inhalation; treatment order was not randomized or blinded.
Outcomes and reported result
SONG-HD fatigue, EQ visual-analogue health score, serum citrullinated histone H3 and selected oxidative/endothelial biomarkers.
Both patients' reported fatigue and EQ-VAS improved during combined therapy and worsened again after return to conventional dialysis; several biomarkers changed in the reported favorable direction. The design cannot separate H₂ inhalation from H₂ dialysate, order, expectation or other time effects.
The complete free PMC report and table were checked for both cases, dual-route dosing, exact H₂ gas flow/purity, patient-reported and biomarker outcomes, reversal observation, limitations and disclosure gaps.
A reported association, difference or mechanism is not automatically a clinical benefit.
Limitations and applicability
Only two unblinded cases, subjective outcomes, combined intervention, no concurrent control and extensive previous exposure to H₂ dialysate. The report names commercial dialysate and H₂-generator products; no explicit funding or conflict statement was identified, so their absence is not inferred.
Hypothesis-generating observations in two long-term dialysis patients; they do not establish efficacy, comparative safety or optimal dosing.
No single-study GRADE certainty rating is assigned. Read how records and evidence assessments are prepared.
Sources and record status
PMID: 39436179 · DOI: 10.4103/mgr.MEDGASRES-D-24-00024
Free full article in PubMed Central.
Complete PMC article and PubMed metadata; full-text extraction checked 9 August 2026.
10 August 2026
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