Restoration of Electrolyte Homeostasis and Microcirculatory Perfusion in End-Stage Renal Disease via Intravenous Oxyhydrogen and Gasotransmitter Nanobubble Therapy Combined with Potassium Titration: A Case Report

Background. Chronic kidney disease (CKD) stage 5, or end-stage renal disease (ESRD), is associated with high mortality, systemic inflammation, oxidative stress, and complex metabolic derangements. Current treatments such as hemodialysis offer life-sustaining support but often fail to address these underlying molecular dysfunctions. This case explores the application of a novel molecular adjuvant therapy integrating intravenous hydrogen-oxygen (HHO) nanobubbles, gasotransmitter nanobubbles (NO, CO, H₂S), and titrated potassium chloride (KCl) in a patient undergoing maintenance dialysis. Case presentation. A 63-year-old male with CKD-5, type 2 diabetes, and uncontrolled hypertension received 21 sessions of post-dialysis intravenous infusions over two months (April–June 2025), comprising HHO nanobubbles, gasotransmitters, and progressively titrated KCl. Baseline symptoms included fluid intolerance (≤200 cc/day), post-dialysis fatigue, cutaneous hyperpigmentation, and poor appetite. Therapeutic response included increased oral fluid tolerance (400 cc/day), improved skin perfusion, appetite restoration, and normalized urination frequency. Laboratory findings showed stabilization of serum potassium (3.95 to 4.25–4.59 mmol/L), reduction in HbA1c (8.1% to 6.69%), and hs-CRP (8.0 to 2.28 mg/L), without adverse events. Discussion. HHO and gasotransmitter nanobubbles exhibit antioxidant, anti-inflammatory, and vasoprotective properties, while titrated KCl addresses critical electrolyte imbalances in ESRD. Together, these agents offer a multi-targeted, systems-level intervention that may mitigate oxidative stress, preserve renal microcirculation, and improve metabolic stability. This aligns with emerging literature on gasotransmitters’ role in renal protection and redox modulation. Conclusion. This case suggests that intravenous nanobubble-based HHO and gasotransmitter therapy, when combined with controlled potassium titration, may safely improve clinical and biochemical parameters in CKD-5 patients on hemodialysis. Larger, controlled studies are warranted to validate efficacy and establish protocols for broader clinical application.