Effect of Nocturnal Hemodialysis versus Conventional Hemodialysis on End-Stage Renal Disease: A Meta-Analysis and Systematic Review.

Fangjie Liu,Li Sun,Linlin Liu,Yiting Sun,Wei Sun,Tianhua Xu,Li Yao,Xin Feng,Jianfei Ma,Lining Wang,Ping-Hsun Wu

doi:10.1371/journal.pone.0169203

Fangjie Liu, Li Sun + Show 9 more

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https://doi.org/10.1371/journal.pone.0169203

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Journal: PloS one	Publication Date: Jan 20, 2017
Citations: 14	License type: CC BY 4.0

Affiliation: First Hospital of China Medical University

Abstract

ObjectivesThe purpose of this study is to assess the efficacy and safety of nocturnal hemodialysis on end-stage renal disease (ESRD) patients.MethodsWe searched Medline, EmBase, and the Cochrance Central Register of Controlled Trials for studies up to January 2016. Analysis was done to compare variant outcomes of different hemodialysis schedules, including mortality, cardiovascular-associated variables, uremia-associated variables, quality of life (QOL), side-effects, and drug usage.ResultsWe collected and analyzed the results of 28 studies involving 22,508 patients in our meta-analysis. The mortality results in this meta-analysis indicated that the nocturnal hemodialysis (NHD) group was not significantly different from conventional hemodialysis (CHD) group (Mortality: OR: 0.75; 95% confidence intervals (CIs): 0.52 to 1.10; p = 0.145), but the CHD group had significantly fewer number of hospitalizations than the NHD group (OR: 1.54; 95%CI: 1.32 to 1.79; p<0.001). NHD was superior to CHD for cardiovascular-associated (left ventricular hypertrophy [LVH]: SMD: -0.39; 95%CI: -0.68 to -0.10; p = 0.009, left ventricular hypertrophy index [LVHI]: SMD: -0.64; 95%CI: -0.83 to -0.46; p<0.001) and uremia-associated intervention results (Serum albumin: SMD: 0.89; 95%CI: 0.41 to 1.36; p<0.001). For the assessment of quality of life, NHD treatment significantly improved the patients’ QOL only for SF36-Physical Components Summary (SMD: 0.43; 95%CI: 0.26 to 0.60; p<0.001). NHD intervention was relatively better than CHD for anti-hypertensive drug usage (SMD: -0.48; 95%CI: -0.91 to -0.05; p = 0.005), and there was no difference between groups in our side-effects assessment.ConclusionNHD and CHD performed similarly in terms of ESRD patients’ mortality and side-effects. NHD was superior to CHD for cardiovascular-associated and uremia-associated results, QOL, and drug usage; for number of hospitalizations, CHD was relatively better than NHD.

Highlights

End-stage renal disease (ESRD) is a chronic and progressive decline in kidney function, which will eventually lead to uremia and death if it is not treated properly [1]
Nocturnal hemodialysis (NHD) was superior to conventional hemodialysis (CHD) for cardiovascular-associated and uremia-associated results, quality of life (QOL), and drug usage; for number of hospitalizations, CHD was relatively better than NHD
A study was eligible for inclusion if the following criteria were met: (1) the trial investigated nocturnal hemodialysis NHD versus conventional hemodialysis CHD; (2) all of patients included with ESRD; and (3) the outcomes variable included one of the following: mortality, cardiovascular-associated variables, uremia-associated variables, quality of life, side-effect, and drug usage