I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: News Articles => Topic started by: Zach on November 13, 2008, 06:43:44 AM
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Overnight hemodialysis dramatically improves survival
11/11/2008 10:26:52 AM
Hemodialysis patients who undergo dialysis three times weekly for eight hours while they sleep have a nearly 80% reduced risk of death, compared to patients who undergo conventional, four-hour dialysis, according to research presented at the American Society of Nephrology's 41st Annual Meeting and Scientific Exposition in Philadelphia.
In a study led by Ercan Ok, MD, of Ege University in Izmir, Turkey, 224 dialysis patients were switched to overnight dialysis. The patients spent three nights a week at the dialysis center where they underwent eight hours of continuous hemodialysis. The patients adjusted well to overnight hemodialysis. "After an adaptation period of a month, all patients slept during the night without any complaint," says Dr. Ok.
The patients remained on overnight hemodialysis for about one year. Their outcomes were compared with those of a similar group of patients who continued on conventional dialysis: four hours, three days per week.
Overnight dialysis led to improvements in a wide range of outcomes. "The hospitalization rate during follow-up was one-fourth of that observed in patients treated with four-hour conventional hemodialysis," comments Dr. Ok. "Most importantly, our results confirmed that longer dialysis produces significantly better patient outcomes, with a 78 percent reduction in mortality rate."
Patients receiving overnight hemodialysis had better blood pressure control, leading to a two-thirds reduction in blood pressure medications. They were also at lower risk of blood pressure drops during dialysis, a common problem with conventional hemodialysis. Levels of the mineral phosphate decreased toward normal, despite a 72 percent reduction in medications used to lessen phosphate absorption.
The need for other medications decreased as well. All of these outcomes either did not change or deteriorated in patients on four-hour conventional dialysis.
Most patients in the overnight hemodialysis group mentioned an increase in appetite. They gained weight, and their serum protein (albumin) levels increased. Many patients were able to return to work, reporting improved job performance and better mental (cognitive) functioning.
More frequent and/or longer dialysis regimens are a promising alternative to addressing the "unacceptably high" risk of death among dialysis patients, according to Dr. Ok. Although home dialysis is may be the best approach (aside from kidney transplantation), it is not an option for most patients.
Previous studies of overnight, thrice-weekly hemodialysis have shown impressive results, with ten-year survival rates as high as 75 percent. The new trial is the first prospective, controlled study to compare the results of eight-hour versus four-hour hemodialysis, performed in the dialysis center.
The study has some important limitations, including the fact that patients were not randomly assigned to the two dialysis strategies. With an average age of 45, the patients were younger than the general population of dialysis patientsfew older patients were willing to switch to overnight hemodialysis. In addition, the follow-up period was relatively short.
However, given the clear superiority of eight-hour dialysis, the researchers do not think the results would be changed with long-term observation. Dr. Ok adds, "We expect that these data would be convincing to the whole of societyincluding physicians, patients, health authorities, and social security institutionsfor the necessity of longer hemodialysis in order to improve high mortality and morbidity."
The study was supported by a grant from the European Nephrology Dialysis Institution. The study was conducted in Fresenius Medical Care (FMC) Turkey clinics. Ercan Ok, MD and Ali Basci, MD are members of the Scientific Advisory Board of FMC Turkey; Siddig Momin Adam, MD, is a nephrologist in a FMC Turkey Clinic.
http://www.physorg.com/news145336758.html
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Old news!!!
:thumbup;
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Good news and hopefully more centers will start making it available.
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Hubby does 5 nights a week 7 hrs a night at home. His survival rate must be dramatically improved!!! :2thumbsup; Nocturnal dialysis is the way to go if you want a much mre "normal" life on dialysis!!!
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Does any one else beside me wonder how many studies it is going to take to convince the medical establishment as a whole that more dialysis is better? 8 hours at night, 3 days a week, or more runs for shorter times more often - the labs are better, the patients feel better. . . .how many studies add up to a big stick?
:Kit n Stik;
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Zach - you didn't like my version? http://ihatedialysis.com/forum/index.php?topic=11005.0
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Zach - you didn't like my version? http://ihatedialysis.com/forum/index.php?topic=11005.0
Opps! Maybe you can combine them?
:waving;
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Does any one else beside me wonder how many studies it is going to take to convince the medical establishment as a whole that more dialysis is better? 8 hours at night, 3 days a week, or more runs for shorter times more often - the labs are better, the patients feel better. . . .how many studies add up to a big stick?
:Kit n Stik;
The problem is finding dedicated doctors willing to take on a "night" shift. Sometimes our doc comes at midnight. Also, to find staff to work nights is hard. It is hard to find the ones who stay awake during the DAY!
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As far as I know there is no Nocturnal dialysis program in-centre run here. Nxstage is also NOT available here. As a Haemo patient you are either a "three times a week" in-clinic patient or you do home haemo (nocturnal or 3/7 which ever you choose). As you all know there are many constraints for some patients to do haemo at home. Nocturnal in-clinic should be offered. There are many reasons why I choose to do PD. Although PD was NOT offered to me. I swapped Nephs and told them what I was doing. I took control of my own dialysis choice.
I think the problem lies with patients not educating themselves on the choices available to them. Demanding change in centers and taking control of their own health plan.
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You have to do what you have to do. I figured out three day a week four hours was killing me slowly and went to bat for my self to get moved to nocturnal to try it out. So far so good. Research is bearing out that this is good for patients.
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This makes sense.