Effects of Three Times Weekly Eight-Hour Nocturnal Hemodialysis on Volume and Nutritional Status

Abstract

Background: This prospective cohort study compared the changes in body water composition and nutritional parameters measured with multifrequency bioimpedance analysis between 8-hour three times weekly nocturnal hemodialysis (NHD) and 4-hour conventional hemodialysis (CHD) patients. Patients and Methods: 55 patients on CHD and 57 patients on NHD were included in the study. Multifrequency bioimpedance analysis was performed at baseline and at the 12th month. The primary outcomes of the study were changes in extracellular water (ECW), fat mass, dry lean mass and phase angle. Secondary outcomes of the study included changes in blood pressure and biochemical parameters related to nutrition and inflammation. Results: ECW/height values decreased in the NHD group, while they increased in the CHD group. Fat mass, dry lean mass, and serum albumin increased and high sensitive CRP decreased in the NHD group but did not change in the CHD group. When changes in parameters from baseline to the 12th month between the groups were compared, NHD was associated with improvement in volume parameter including ECW/height (difference -0.44 l/m, p < 0.001). Change in blood pressure was not different between the groups, however requirement for antihypertensive medication decreased from 26.5 to 8.5% in the NHD group (p = 0.002). NHD was also associated with increases in fat mass (difference 1.8 kg, p < 0.001), dry lean mass (difference 0.6 kg, p = 0.006), serum albumin (difference 0.19 g/dl, p < 0.001) and cholesterol (difference 18.8 mg, p < 0.001). Phase angle values decreased in the CHD group but did not change in the NHD group (difference between the groups 0.37°, p = 0.04). Conclusion: This study revealed that longer HD facilitates volume control and improves nutritional status.

Eight-Year Experience with Nocturnal, Every-Other-Day, Online Haemodiafiltration

“…Most studies have found that phosphate removal is better with long-duration nocturnal haemodialysis than with conventional treatment and that there is a lower use of phosphate binders [5,6,16,20,21,22]. In our study, better phosphate control was also observed with a reduced need for phosphate binders from 84% to total withdrawal.…”

“…Since then, the contribution of dialysis duration has been under debate. However, similar experiences were published only after 2009 from Canada [5,16], the United Kingdom [17,18], the United States [19], Germany [6], Turkey [20,21], and Slovenia [22]. An every-other-day haemodialysis scheme has been used by the Lecce group since 1972 to avoid long weekend periods [10], but no other experiences have been reported, even though the long weekend interval is known to increase the risk of mortality [23,24].…”

“…David et al [6] found a significant improvement in nutritional status assessed by body weight (1.2 kg after 12 months), body mass index, nPCR and bioelectrical impedance. Both Turkish studies of long-term dialysis [20,21] found that body weight increased by 1.6-1.8 kg in patients who completed 1 year of follow-up.…”

“…Reduction of antihypertensive therapy has been published in several reports of in-centre long nocturnal treatments [5,6,20,21,31]. It has been suggested that long haemodialysis controls hypertension by reducing sympathetic tone [32] and by more efficiently removing pressor substances [33] and that low ultrafiltration rates reduce the risk of intradialytic hypotensive episodes and fluid overload [34].…”

Home Hemodialysis Dose: Balancing Patient Needs and Preferences

“…Nutritional parameters have been examined in a number of studies on intensified HD, both in-center and at home, but the data are inconsistent [20]. Most recently, the effect of thrice weekly, nocturnal hemodialysis on nutrition was examined in 55 conventional and 57 nocturnal patients [21]. After 12 months of prescribed treatment, patients on nocturnal HD had significantly improved serum albumin compared to conventional HD patients.…”