Impact Of Nocturnal Hemodialysis Research Articles

The impact of nocturnal hemodialysis on sexual function

BackgroundSexual dysfunction is common in patients with end stage renal disease (ESRD) and treatment options are limited. Observational studies suggest that nocturnal hemodialysis may improve sexual function. We compared sexual activity and responses to sexual related questions in the Kidney Disease Quality of Life Short Form questionnaire among patients randomized to frequent nocturnal or thrice weekly conventional hemodialysis.MethodsWe performed a secondary analysis of data from an RCT which enrolled 51 patients comparing frequent nocturnal and conventional thrice weekly hemodialysis. Sexual activity and responses to sexual related questions were assessed at baseline and six months using relevant questions from the Kidney Disease Quality of Life Short Form questionnaire.ResultsOverall, there was no difference in sexual activity, or the extent to which people were bothered by the impact of kidney disease on their sex life between the two groups between randomization and 6 months. However, women and patients age < 60 who were randomized to frequent nocturnal hemodialysis were less bothered by the impact of kidney disease on their sex life at 6 months, compared with patients allocated to conventional hemodialysis (p = 0.005 and p = 0.024 respectively).ConclusionsOur results suggest that frequent nocturnal hemodialysis is not associated with an improvement in sexual activity in all patients but might have an effect on the burden of kidney disease on sex life in women and patients less than 60 years of age. The validity of these subgroup findings require confirmation in future RCTs.

Impact of nocturnal hemodialysis on the variability of heart rate and duration of hypoxemia during sleep

Nocturnal hemodialysis (NHD) alleviates uremia-related sleep apnea, a condition characterized by increased sympathetic activity and diminished heart rate (HR) variability. We tested the hypothesis that NHD reduces both hypoxemia and sympathetic neural contributions to HR variability during sleep. Episodes of apnea and hypopnea and the duration of nocturnal hypoxemia during sleep were determined in 9 end-stage renal disease (ESRD) patients (age: 44 +/- 2) (mean +/- SEM) before and after conversion from conventional hemodialysis (CHD) to NHD, and in 10 control subjects (age: 45 +/- 3) with normal renal function and without sleep apnea. Low frequency (LF) (0.05-0.15 Hz) and high frequency (HF) (0.15-0.5 Hz) HR spectral power during stage 2 sleep was calculated (Fast Fourier transformation). Patients were studied 4 times (1 day before and on the night after their CHD session) and 6-15 months after conversion to NHD, while receiving NHD and on a non-dialysis night. NHD decreased the frequency of apnea and hypopnea (from 29.7 +/- 9.3 to 8.2 +/- 2.0 episodes per hour, P= 0.02), and duration of nocturnal hypoxemia (from 13.9 +/- 5.2 to 2.6 +/- 1.9% of total sleep time, P= 0.02). As CHD recipients, ESRD patients had faster nocturnal heart rates (79 +/- 2 vs. 58 +/- 1 min-1, P= 0.03) and lower HF (vagal) (78 +/- 27 vs. 6726 +/- 4556 ms2, P= 0.001) spectral power than control subjects. After conversion to NHD, HR fell (from 79 +/- 2 to 66 +/- 1 min-1, P= 0.03) and HF power increased (from 78 +/- 27 to 637 +/- 139 ms2, P= 0.001). The HF/HF+LF ratio, an index of vagal HR modulation, was lower during CHD (0.16 +/- 0.03 vs. 0.42 +/- 0.05 in control subjects, P < 0.05) and increased (to 0.45 +/- 0.05, P < 0.001) after conversion to NHD. The LF/HF ratio, a representation of sympathetic HR modulation, which was significantly higher during CHD than in control subjects (2.77 +/- 0.82 vs. 0.71 +/- 0.11, P < 0.05), was also normalized by NHD (0.74 +/- 0.12, P < 0.05, compared with CHD). Higher heart rates and impaired vagal and augmented sympathetic HR modulation during sleep in ESRD patients are normalized by NHD. Potential mechanisms for these observations include attenuation of surges in sympathetic outflow elicited by apnea and hypoxia during sleep, normalization of nocturnal breathing patterns that influence HRV, and removal, by increased dialysis, of a sympatho-excitatory stimulus of renal origin.

Daytime sleepiness in patients with CRF: Impact of nocturnal hemodialysis

Background: Patients with end-stage renal disease (ESRD) have a high prevalence of sleep disorders, which are not improved by conventional hemodialysis (CHD). Although sleep disorders are commonly associated with complaints of excessive daytime sleepiness, the severity and pathogenesis of daytime sleepiness has not been evaluated objectively in patients with ESRD. Nocturnal hemodialysis (NHD) is a new technique that provides better clearance of uremic toxins than CHD and, consequently, may improve sleep quality and daytime sleepiness. The authors wished to determine the severity and pathogenesis of daytime sleepiness in patients with ESRD and evaluate the impact of NHD. Methods: Sleep quality was monitored by overnight polysomnography, and daytime sleepiness was assessed by the multiple sleep latency test (MSLT). These measurements were performed in 24 patients (15 men and 9 women, 44 ± 10 years) while on treatment with CHD and were repeated in 15 patients after conversion to NHD. Results: The majority (54%) of patients on CHD were pathologically sleepy (somnolent group, mean sleep latency <5 minutes), and, in comparison with the remaining patients (alert group, mean sleep latency >5 minutes), their blood urea nitrogen (BUN; 77.9 ± 9.8 v 60.2 ± 12.0 mg/dL, P < 0.001; 27.8 ± 3.5 v 21.5 ± 4.3 mmol/L; P < 0.001), and periodic limb movement (PLM) index (57 ± 47 v 6 ± 10/hr; P = 0.002) were significantly higher. Furthermore, sleep latency was correlated with BUN (R = 0.58, P = 0.008). After conversion to NHD, there was a significant fall in BUN and the severity of sleep apnea, but the overall frequency of PLM and sleep fragmentation remained elevated. Nevertheless, there was a trend for the Somnolent group to become less sleepy on NHD, and this was associated with a modest reduction in the frequency of PLM. Conclusion: Excessive daytime sleepiness occurs in approximately 50% of patients with ESRD. The etiology appears to be related both to uremia and sleep fragmentation associated with PLM. Am J Kidney Dis 41:403-410.