Long slow night hemodialysis and quality of life

Abstract

Background: Long slow hemodialysis (LS‐HD) improves many biochemical parameters compared with conventional HD. However, its influences on quality of life are less well known. Aims: The objective of this study was to examine the quality of life of patients on LS‐HD performed overnight compared to the patients on standard hemodialysis. This extends the previous study, conducted in 2001, which examined the LS‐HD patients, quality of life. Patients and methods: We sent questionnaires to 12 LS‐HD (overnight, treatment time 8 h × 3/wk) patients and 15 day HD (4.5 h × 3/wk) patients, all being treated using the limited care method. Data was collected using two different structured questionnaires. One was constructed for a previous study (2001) and the other one was a standardized set of questionnaires (RAND‐36). Research material was collected from patient documents, such as the essential biochemical parameters, blood pressure, weight gain, and weekly EPO doses were recorded. Ten of the LS‐HD patients (83%) and 13/15 (87%) of day HD patients returned the questionnaires. Three day hemodialysis patients returned empty questionnaires, which were disqualified. Results: Based on the medical facts, the results showed that the patients of LS‐HD felt better than the patients in another group. Patients on the LS‐HD had higher Kt/V (2.623 vs. 1.577) and Hb (118 vs. 111) and lower Pi (1.36 vs. 1.63) and EPO dose (epoietin‐beta 2667 ky/week vs. 5833 ky/week; darbepoetin 16 ky/week vs. 37 ky/week). However, their predialysis BP as well as the weight gain between treatments and salt and fluid balances caused problems furthermore. The experiences of the therapy of the LS‐HD patients were more positive than of the control group: they felt their medical condition was better than of the patients on day HD. However we didn’t observe significant differences in the replies showing physical or psychosocial conditions between the two groups. Conclusions: The study suggests that when patients can themselves make the choice between treatment modalities, it improves the quality of life of the patients. Control of anemia is improved in LS‐HD overnight patients with lower doses of EPO. The LS‐HD gives the patients more freedom of diet. However, more attention must be paid to salt and fluid restriction. The LS‐HD makes it possible for many patients to work normally.