Effect of Long Nocturnal Dialysis on Nutritional Status and Blood Pressure Control

Abstract

Objective: Nutritional status is an important predictor of outcome in dialysis patients. Long nocturnal dialysis (LND) improves clearances, and potentially can have a beneficial impact on nutritional status and on blood pressure control. Methods: Retrospective analysis of a prospectively collected database of 12 patients in a LND program. Patients were dialysed 3*/week during 8 hours, at a Qb of 175–200 ml/min and a Qd of 500 ml/min. Pre-dialysis serum albumin (nephelometric), ideal body weight, systolic blood pressure and residual GFR were measured just before start of LND, and after 1 year. Results: Mean Kt/v for urea over the 1 year period was 1.9 ± 0.29/session. Serum albumin increased from 3.83 ± 0.18 to 4.12 ± 0.28 mg/dl (paired T-test : p = 0.007). Ideal body weight increased nonsignificantly from 75.08 ± 15.35 to 78.07 ± 13.49 kg (paired T-test, p = 0.39). Systolic blood pressure decreased from 146.3 ± 21.7 to 132.8 ± 17.3mmHg (paired T-test, p = 0.06) Discussion: Malnutrition is an important predictor of outcome in dialysis patients. Several studies have pointed that an intensification of dialysis adequacy can lead to an enhanced nutritional status. The use of daily dialysis or of nocturnal dialysis can substantially improve delivered Kt/V, as is shown in our patient group. There was a concommitant rise in pre-dialysis serum albumin concentration in all patients. There was also tendency for an increase in total body weight, although this did not reach statistical significance, and was also not present in all patients. This might just be a false impression as the improvement of the pre-dialysis blood pressure might indicate that excess fluid was gradually removed, with an increase in lean body mass and a resulting stable total body weight. In conclusion, LND is well-tolerated, and results in an improvement of serum albumin and pre-dialysis systolic blood pressure.