Nocturnal Hemodialysis Is Better Than Quotidian Hemodialysis

Abstract

Background. It is unknown whether long nocturnal (6–7 times weekly 6–8 hours) hemodialysis (NHD) is better than frequent short hemodialysis (‘daily’, quotidian hemodialysis, QHD). Methods. A Dutch NHD pilot study (‘Nocturne’) started in December 2001. We can now evaluate effects of 4 months NHD in 14 patients. Baseline dialysis frequency was 3.5 or less (3.13 ± 0.23, M ± SD) in group A (n = 8), and 4 or more (5.0 ± 0.89) in group B (n = 6), weekly dialysis time was equal in both groups. Results. Single pool Kt/V, being higher in group B at baseline, increased in both groups (A: 3.1 ± 0.8/week to 9.5 ± 2.3, B: 3.8 ± 1.0 to 10.9 ± 4.1). Baseline nPCR, being higher in group B, increased in both groups (A: 1.0 ± 0.3 g/kg/week to 1.4 ± 0.3, and B: 1.2 ± 0.5 to 1.8 ± 0.5). Baseline albumin was higher in group B, and increased in group A (39.6 ± 3.7 g/l to 43.2 ± 1.5), not in B (41.4 ± 2.3 to 42.8 ± 2.3). Target weight increased only in group A (71.8 ± 10.5 kg to 75.3 ± 11.9), not in B (71.4 ± 25.5 to 71.3 ± 26.7). NHD resulted in normophosphatemia in both groups despite phosphate supplementation and cessation of phosphate binders. PTH decreased in both groups (A: 40.6 ± 38.0 pmol/l to 14.4 ± 11.7, B: 35.6 ± 37.7 to 22.4 ± 41.5). In both groups, pre- and postdialysis mean arterial pressure decreased (A: 106.8 ± 7.9 mmHg to 94.4 ± 12.1 and 97.3 ± 9.5 mmHg to 86.3 ± 8.2, B: 102.2 ± 28.4 to 89.4 ± 9.5 and 90.3 ± 26.8 to 82.7 ± 12.9). Antihypertensives were discontinued or markedly reduced. Fatigue, insomnia, prurigo, restlessness, appetite, physical condition, working ability and quality of life (SF36) improved significantly in both groups. Conclusion. This small pilot study suggests that phosphate and PTH control, blood pressure, uremic symptoms and quality of life improve when conventional hemodialysis or QHD patients switch to NHD. Nutritional parameters improve only in the previously conventionally treated group.