Overnight HD Could Improve Outcomes

Overnight HD Could Improve Outcomes
John Schieszer
January 22 2009

Patients undergoing hemodialysis overnight for eight hours thrice weekly had a reduced death risk

PHILADELPHIA—Hemodialysis (HD) patients who undergo dialysis for eight hours overnight three times a week may reduce their death risk by nearly 80% compared with conventional four-hour HD three times a week, data suggest.

In a study led by Ercan Ok, MD, professor of medicine and nephrology at Ege University in Izmir, Turkey, investigators switched 224 patients receiving conventional HD to a regimen in which they spent three nights at a dialysis center receiving eight hours of continuous HD. The patients remained on this regimen for about one year and adjusted well to it, Dr. Ok said. “After an adaptation period of a month, all patients slept during the night without any complaint,” he said.

He and his colleagues observed that overnight dialysis was associated with improvements in various outcomes. “The hospitalization rate during follow-up was one-fourth that observed in patients treated with four-hour conventional hemodialysis,” Dr. Ok said. “Most importantly, our results confirm that longer dialysis produces significantly better patient outcomes, with a 78% reduction in mortality rate.”

Patients receiving overnight HD had better BP control, leading to a two-thirds reduction in BP medication use, Dr. Ok reported. Phosphate levels decreased toward the normal range despite a 72% reduction in phosphate binder use. In addition, patients had a lower risk of hypotension during dialysis. All these outcomes either did not change or deteriorated in patients on conventional HD.

Most patients in the overnight group reported an increase in appetite. They gained weight, and their serum albumin levels increased. Many were able to return to work and reported improved job performance and better cognitive function.

More frequent and longer dialysis regimens are a promising alternative to addressing the “unacceptably high” risk of death among dialysis patients, Dr. Ok said. Although home dialysis may be an ideal approach, it is not always an option for many patients.

Previous studies of thrice-weekly overnight HD have shown impressive results, with 10-year survival rates as high as 75%. This new study is the first prospective, controlled investigation to compare the results of eight-hour vs. four-hour HD performed in a dialysis center.

“I was partly surprised when I observed that almost all the patients adapted well enough to sleep during dialysis at the center,” Dr. Ok told Renal & Urology News. “It happened in just one month. I want to believe that longer night dialysis will be performed more in the near future and in many countries.”

Dr. Ok noted that the study had some important limitations. Assignment to the two dialysis strategies was not random and, with an average age of 45 years, the patients were younger than the general dialysis population. Few older patients were willing to switch to overnight HD. In addition, the follow-up was relatively short. Still, given the clear superiority of eight-hour dialysis, he does not think the results would be different with a longer period of observation.

His study findings should convince physicians, patients, and health authorities of the benefit of longer HD in terms of decreased morbidity and mortality.

http://www.renalandurologynews.com/Overnight-HD-Could-Improve-Outcomes/PrintArticle/126239/