In-center Nocturnal Hemodialysis Research Articles

In-center Nocturnal Hemodialysis

Some patients are not optimally treated by conventional in-center hemodialysis (HD) and are unable to perform home HD. We examined the effect of in-center thrice-weekly nocturnal HD (INHD) on patient outcomes. Patients who were not optimally treated on conventional HD were offered INHD. Thirty-nine patients' laboratory data and medication use were analyzed for the 12 mo before and after conversion to INHD until September 1, 2007. Quality of life on conventional HD and INHD was compared. After conversion to INHD, median values for phosphorus decreased from 5.9 to 3.7 mg/dl (P < 0.01), alkaline phosphatase level increased from 84 to 161 U/L (P < 0.01), and percentage reduction in urea increased from 74 to 89% (P < 0.01). The mean number of antihypertensive drugs prescribed declined from 2.0 to 1.5 (P < 0.05) during the course of INHD, and the mean daily dosage of phosphate binders declined from 6.2 to 4.9 at study end (P < 0.05). There was a significant reduction in erythropoietin-stimulating agent use of 1992 U/wk (P < 0.01). There was no significant change in median hemoglobin, iron saturation, corrected calcium, or parathyroid hormone levels. Overall, quality of life, sleep, intradialytic cramps, appetite, and energy level all improved significantly on INHD. INHD offers an effective form of HD for long-term dialysis patients who are unable to perform home HD.

Evidence for enhanced transsulphuration (TS) as a mechanism underlying lower hyperhomocysteinemia in patients undergoing home nocturnal hemodialysis (HNHD)

ObjectivesElevated plasma total homocysteine (tHcy) &gt;12μmol/L, an independent risk factor for cardiovascular disease, is prevalent (&gt;85%) in patients undergoing standard hemodialysis (SHD). The current study was conducted to determine if lower tHcy associated with longer, more frequent dialysis (HNHD) is a function of dialysate HCY losses and/or enhanced HCY metabolism through the TS pathway (cysteine (Cys) and sulphate production).MethodsA cross‐sectional study including patients (n=33) on SHD (4 h, 3 days/wk), in‐centre nocturnal hemodialysis (INHD) (6‐8 h, 3 nights/wk) and HNHD (6‐8 h, 5‐7 nights/wk). Blood and dialysate were collected during a mid‐week dialysis session.ConclusionsThese data suggest that increased dialysate removal of Hcy alone does not explain lower plasma tHcy in HNHD. Rather, increased clearance of sulfate and cysteine may allow increased TS in patients on HNHD. Supported by Kidney Foundation of Canada

Thrice-Weekly In-Center Nocturnal Hemodialysis: An Effective Strategy to Optimize Chronic Dialysis Therapy

Daily nocturnal hemodialysis (NHD) has been proposed as a valuable strategy to improve outcomes for patients on conventional hemodialysis (CHD), but it is burdened by high costs and logistic issues. Thrice NHD might represent a more affordable approach to improve hemodialysis patient outcome. Here we retrospectively analyzed the data on blood pressure, body weight, and hematochemical parameters in a cohort of 7 patients (mean age 50.4-/+11.0 years, duration of CHD 14.3-/+11.5 years) who registered in the NHD program at the dialysis unit of Ospedali Riuniti, Bergamo, Italy. Data for the 2 first years of NHD were compared with those of the last year on CHD. At 2 years after start of NHD, we found a significant decrease in systolic (149.4-/+16.6 vs. 128.4+/-26.0 mm Hg, p<0.001) and diastolic (87.7-/+11.1 vs. 79.6-/+16.7 mm Hg, p<0.05) blood pressure, along with a significant reduction in the use of per-patient antihypertensive agents (1.17-/+1.19 vs. 0.47-/+0.89, p<0.05 and an increase in dry body weight (61.4-/+21.8 vs. 67.1-/+16.4 kg, p<0.001). Moreover, patients had a significant reduction in phosphate levels (6.2-/+2.4 vs. 5.4-/+3.0 mg/dL, p<0.01). The procedure was safe and well tolerated and did not require extra cost for ad hoc facilities. NHD is an effective approach to optimize chronic dialysis therapy.

Effects of Nocturnal Hemodialysis on Melatonin Rhythm and Sleep-Wake Behavior: An Uncontrolled Trial

End-stage renal disease and its treatment are associated with sleep disturbances such as deterioration of the circadian sleep-wake pattern. Melatonin rhythm, which has an important role in this pattern, is disturbed. The nocturnal melatonin surge is absent in this population. Whether nocturnal in-center hemodialysis changes melatonin and sleep-wake rhythms is unknown. A nonrandomized uncontrolled trial. Patients served as their own controls. Thirteen daytime hemodialysis patients (median age, 58 years; 5 women) from our hospital receiving conventional daytime hemodialysis 3 times weekly for 3 to 4 hours each session. Six months of treatment with nocturnal in-center dialysis 4 nights/wk with 8-hour sessions. At baseline, while still on conventional hemodialysis therapy, polysomnography was performed, sleep questionnaires were filled out, and melatonin concentration in saliva was obtained. After 6 months of in-center nocturnal hemodialysis, all measurements were repeated. After 6 months of in-center nocturnal hemodialysis, polysomnography showed significant improvements in sleep efficiency (P = 0.05) and stage 3/4 sleep (P = 0.03) in comparison to t = 0. Trends in improvement of rapid-eye-movement sleep, awake time, and oxygen saturation were seen after 6 months of in-center nocturnal hemodialysis therapy. Sleep questionnaires showed a trend in improved sleep quality and daytime function. Patients were less exhausted during the daytime. The nocturnal melatonin surge was partially restored. Small sample size and a nonrandomized uncontrolled study design. Patients after 6 months of in-center nocturnal hemodialysis had significant improvements in subjective and objective sleep parameters and partially restored nocturnal melatonin rhythm.

A Thrice Weekly In-Center Nocturnal Hemodialysis Program

The mortality associated with hemodialysis (HD) remains high. Recent studies have found that a session time of 4 to 4.5 hours and an ultrafiltration rate of less than 10 cc/h/kg were each independently associated with a decreased mortality among HD patients. We started a thrice-weekly nocturnal HD program in May 2005 and have since enrolled a total of 16 patients. The Kt/V urea (2.6 +/- 0.65 vs. 1.2 +/- 0.16, mean +/- SD, P < .05) and serum phosphorus (4.4 +/- 1.1 v 5.3 +/-1.3 mg/dL, P =.049) values obtained 6 months after enrollment in the nocturnal HD program were significantly better than the baseline values obtained before the initiation of the nocturnal HD program. The ultrafiltration rate was 5.9 +/- 1.7 mL/h/kg 6 months after patients participated in the nocturnal HD program, whereas the rates for these same patients at baseline was 10.3 +/- 4.5 mL/h/kg. Psychosocial assessments were performed at baseline and again at 6 months. No difference was seen in the results of these assessments. We conclude that patients receiving long, in-center thrice-weekly nocturnal HD have a decrease in serum phosphate, an improvement in urea clearance, and a reduction in ultrafiltration rate to less than 10 mL/h/kg. This therapy appears to have no negative impacts on a variety of quality of life measures.

American society of nephrology annual meeting San Diego, California, November 14–19, 2006

American society of nephrology annual meeting San Diego, California, November 14–19, 2006