Patients who received hemodialysis at night six times a week for treatment of end-stage kidney disease had improvements on certain outcomes, compared to patients who received conventional hemodialysis three times weekly like improvement in selected quality of life measures, reduced need for blood pressure medications.
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.
"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.