In-center Nocturnal Hemodialysis

Abstract

Results: 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.Conclusions: INHD offers an effective form of HD for long-term dialysis patients who are unable to perform home HD.

Nocturnal intermittent hemodialysis

“…In a second large study, serum phosphate levels were also significantly lower in patients on NIHD (5 mg/dl) than in those on conventional dialysis (5.73 mg/dl) [26]. In three of the five smaller studies, phosphate control (lower serum phosphate levels and/or lower amount of phosphate binders) improved [27,29,30], while no change was encountered in the remaining two studies [28,31].…”

“…In the large retrospective study conducted by Lacson et al, the quality of life was not investigated [26]. In contrast, three of the smaller studies [27,30,31] did report an improvement in the quality of life. For example, Bugeja et al investigated the quality of life using a self-developed questionnaire and found that the quality of life improved after patients switched to NIHD [27].…”

“…Lacon et al reported an increase in hemoglobin levels in the NIHD group from 11.8 to 12.2 g/dl, while hemoglobin levels in the conventional dialysis group were stable [26]. In three smaller studies, anemia control (higher hemoglobin levels and/or lower erythropoietin doses) improved [27,28,30]; in one study no difference in anemia control was found [31]. [25].…”

“…Lacson et al reported on the lower predialytic systolic blood pressure levels of NIHD patients [150 vs. 147 mmHg (controls)] [26]. In all smaller studies an improvement in blood pressure control (lower blood pressure and/or lower amounts of antihypertensive drugs and/or reduction of left ventricular mass) could be observed [27][28][29][30][31].…”

“…In a retrospective study, Lacson et al compared 746 patients on in-center NIHD using a propensity score to 2,062 matched patients on conventional dialysis [26]. These are the two largest studies on NIHD published to date; other published studies often lack control groups or only include a small number of patients [27][28][29][30][31] (Table 1). In addition, the parameters investigated differ widely among these studies.…”