Nocturnal Hemodialysis Improves Productivity of End-Stage Renal Failure Patients

Abstract

Background: End-stage renal disease (ESRD) patients undergoing conventional in-center hemodialysis (CHD)[3 sessions per week, 4 hours/session] have poor productivity which often results in unemployment. Nocturnal hemodialysis (NHD)[5–6 sessions per week, 8hours/session] is a novel home-based renal replacement therapy, which has been shown to have significant clinical improvements; including: blood pressure control, regression of left ventricular (LV) hypertrophy and restoration of impaired LV systolic function. The objective of our current study is to examine the impact of NHD on the productivity of ESRD patients before and after conversion from CHD to NHD. Methods: We conducted a retrospective survey of all NHD patients (n = 26) at the Toronto General Hospital, University Heath Network from May 1999 to Dec 2001. The parameters examined included (1. duration of NHD, 2. employment status, and 3. hours of productivity) before and after conversion from CHD to NHD. Paired Student t-Test was used to detect statistical significance. Results: Twenty-six patients (age:40 ± 10; mean ± SD) were included in our study. The mean duration of NHD in our cohort was 1.7 ± 0.9 years. Although, employment status were similar before and after conversion to NHD (CHD: 20/26 versus NHD: 21/26), there was a significant increase in the hours of productivity, CHD: 27.4 ± 18 hours per week versus NHD: 36.9 ± 21.7; p = 0.006. Conclusion: NHD is associated with a significant improvement in productivity in ESRD patients. NHD may be the modality of choice to restore ESRD patients the ability to pursue a normal lifestyle.