Nocturnal hemodialysis does not improve overall measures of quality of life comp

[okarol]

Original Article

Kidney International advance online publication 24 December 2008; doi: 10.1038/ki.2008.639
Nocturnal hemodialysis does not improve overall measures of quality of life compared to conventional hemodialysis

Braden J Manns1,2, Michael W Walsh1,2, Bruce F Culleton1, Brenda Hemmelgarn1,2, Marcello Tonelli3, Melissa Schorr1 and Scott Klarenbach3 for the Alberta Kidney Disease Network

   1. 1Department of Medicine, University of Calgary, Calgary, Alberta, Canada
   2. 2Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
   3. 3Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

Correspondence: Braden J. Manns, Foothills Medical Center, 1403-29th Street NW, Calgary, Alberta T2N 2T9, Canada. E-mail: braden.manns@calgaryhealthregion.ca

Received 23 July 2008; Revised 18 September 2008; Accepted 21 October 2008; Published online 24 December 2008.
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Abstract

We conducted a randomized controlled trial to compare the quality of life of 52 patients undergoing nocturnal hemodialysis and conventional hemodialysis. Quality of life was measured using a number of established methods including the Kidney Disease Quality of Life Short Form and the preference-based Euroqol EQ-5D questionnaire (whose scores varied from 0 to 1). The primary outcome was a change in the Euroqol EQ-5D index scores between baseline and 6 months. We performed additional analyses comparing change in quality of life from pre-randomization (when patients were unaware of treatment allocation) to 6 months. Other analyses considered the impact of nocturnal hemodialysis on four pre-selected Kidney Disease Quality of Life Short Form domains, and the longer term impact of nocturnal hemodialysis on quality of life. Compared with conventional hemodialysis, nocturnal hemodialysis increased Euroqol-EQ-5D index scores by 0.05, which was not significantly different from baseline. When six-month values were compared with pre-randomization values rather than baseline values, the between group difference was larger (0.12) though it was still not statistically significant (P=.06). Nocturnal hemodialysis was associated with clinically and statistically significant improvements in selected kidney-specific quality of life domains (P=.01 for effects of kidney disease; P=.02 for burden of kidney disease). Our primary quality of life analysis did not demonstrate a statistically significant change between nocturnal hemodialysis and conventional hemodialysis, though statistically significant and clinically important changes in some secondary kidney-disease- specific measures were observed.
Keywords:

clinical trial, dialysis, end-stage kidney disease, home hemodialysis, nocturnal hemodialysis, quality of life

http://www.nature.com/ki/journal/vaop/ncurrent/abs/ki2008639a.html

[Zach]

A sad day for us all who believe in optimal dialysis.

[Wallyz]

I want to see those instruments first, before accepting the validity of this.  I scored really low on the quality of life survey i was given, simply becasue it measures quality of life against the expectations of the patient.    My expectations are high, because I am much healthier.  That result would fit this result model well, but it does not reflect the truth that I am much, mcuh better off doing daily home hemo.

Secondly, it this measuring daily nocturnal home hemo, or 3x week nocturnal?

[kitkatz]

What?? Oh my goodness someone needs to talk to younger patients and people who have lives instead of people who are really sick on dialysis or such nonsense, before saying things like this!  My quality of life has improved I have time after work to get lesson plans and grades done and to tutor students.  I have my evenings back in which to do things with hubby.  I sleep fairly well at the dialysis center. My lab results are better and better every time I get them. Please do not let one thing people say shut down the nocturnal programs.  Some of us need it.

[kitkatz]

I noticed it is a Canadian study. Maybe all the snow went to their heads!   

[Bill Peckham]

I'm working on a post ... I wrote DR. Manns who is listed as the contact he pointed to me an article published in JAMA on September 19, 2007 - both that paper and this new paper are drawing from the same data set.

Effect of Frequent Nocturnal Hemodialysis vs Conventional Hemodialysis on Left Ventricular Mass and Quality of Life
It concluded:
In conclusion, compared with conventional hemodialysis, nocturnal hemodialysis regressed LV mass, reduced blood pressure, improved measures of mineral metabolism, and improved selected measures of HRQOL. It is unlikely that future studies will be powered to detect differences in clinical outcomes such as mortality. Cost analyses are planned alongside this clinical trial. 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.


So taken together the way I read this data is that clinically daily nocturnal decreases mortality and ill health risks associated with severe kidney disease and DOES NOT DECREASE quality of life

If people hoped to find that life doing daily nocturnal is all flowers and puppies, then the study is a disappointment but I think that is an unrealistic expectation. Life is going to be a struggle if you have severe kidney disease. Nocturnal does not give you back your previously carefree urinating lifestyle. I'm not sure what change we should expect in one's perception of their quality of life. Nocturnal dialysis, particularly frequent nocturnal dialysis, is safer because it is a more complete treatment of the underlying problem severe CKD - the study backs that up. Is it easier? Will your life be "better" if you switch? I think it depends a lot on the incenter experience you're comparing it to.

[Rerun]

It doesn't take a genius to figure out that 24 hours of hemodialysis per week is better than 9.  I feel tons better than on conventional.