Sep. 21, 2007 Patients who received hemodialysis at night six times a week for treatment of end-stage kidney disease had improvements on certain outcomes, including reduced need for blood pressure medications and improvement in selected quality of life measures, compared to patients who received conventional hemodialysis three times weekly, according to an article in the September 19 issue of JAMA.
Despite advances in dialysis and medical therapies, patients with end-stage renal (kidney) disease (ESRD) have annual rates of death that exceed 15 percent. Cardiovascular disease, specifically heart failure or sudden death, is responsible for the majority of deaths, according to background information in the article. Some recent studies have suggested that nocturnal hemodialysis might improve clinical outcomes in ESRD patients.
Bruce F. Culleton, M.D., M.Sc., formerly of the University of Calgary, Alberta, Canada, and colleagues conducted a study to determine the effects of frequent nocturnal hemodialysis compared with conventional hemodialysis on certain outcomes, including left ventricular (LV) mass, health-related quality of life (HRQOL), blood pressure and mineral metabolism.
The randomized controlled trial was conducted at two Canadian university centers between August 2004 and December 2006. A total of 52 patients undergoing hemodialysis were recruited. Participants were randomly assigned to receive nocturnal hemodialysis six times weekly or conventional hemodialysis three times weekly.
"Our findings indicate that frequent nocturnal hemodialysis improves LV mass, systemic blood pressure, abnormalities of mineral metabolism, and possibly HRQOL compared with conventional thrice-weekly hemodialysis," the authors write.
LV mass decreased by an average of 13.8 grams in the nocturnal hemodialysis group and increased by 1.5 grams in the conventional hemodialysis group, for a difference of 15.3 grams. Frequent nocturnal hemodialysis was associated with a reduction in or discontinuation of antihypertensive medications (16/26 patients in the nocturnal hemodialysis group vs. 3/25 patients in the conventional hemodialysis group). No benefit in anemia management was seen with nocturnal hemodialysis.
"If it is found that nocturnal hemodialysis has a favorable cost-benefit profile compared with other dialysis therapies, then consideration should be given to expansion of nocturnal hemodialysis centers, specifically for patients who wish to trade a more demanding therapy for less cardiovascular risk and a potential of improved quality of life," the researchers conclude.
Referenc: JAMA. 2007;298(11):1291-1299.
Editorial: Frequent Nocturnal Hemodialysis--A Step Forward?
In an accompanying editorial, Alan S. Kliger, M.D., of the Hospital of St. Raphael and Yale University, New Haven, Conn., comments on the study examining nocturnal hemodialysis.
"The randomized controlled trial (RCT) by Culleton et al is important for nephrology, clearly demonstrating reduced left ventricular hypertrophy with nocturnal hemodialysis. It would be interesting to see the effect of nocturnal hemodialysis on cardiac structure and function beyond the 6-month study period examined. While future studies may provide additional information, the RCT by Culleton et al suggests that nocturnal hemodialysis may help improve the high morbidity and mortality of North American dialysis patients."
Reference for editorial: JAMA. 2007;298(11):1331-1333.
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