More find nighttime is the right time for dialysis

December 27, 2009

More find nighttime is the right time for dialysis

Kidney patients see extra benefits from nocturnal treatment

By Shari Rudavsky
shari.rudavsky@indystar.com

Three nights a week, Victor Malone settles into a recliner, boots up his laptop, logs on to the Internet and prepares to study for the next six or so hours.

The college student is also tethered to a kidney dialysis machine.

Malone, 40, has joined a growing number of dialysis patients opting to undergo their treatments overnight rather than during the customary day shift. Not only does nocturnal dialysis free up a patient's day for other activities, it also can result in a better outcome, proponents say.

Patients on dialysis at night stay on the machine for six to eight hours, while daytime dialysis runs for four hours. The longer time allows nocturnal dialysis patients to experience a gentler, more thorough form of the therapy, experts say.

Last spring, the staff at DaVita Westview Dialysis offered Malone a chance to switch to nights, an option they had just begun to offer. Within a few months, Malone saw a marked change.

His lab numbers crept into the normal range, his complexion improved, his appetite returned, he stopped carrying extra fluid and he stopped needing some of his medications.

This fall, he started working on an online degree in business and health-care management at the University of Phoenix.

"Seeing what nocturnal has done for me, the days just can't compete," he said.

At DaVita Westview, the 10 slots for nocturnal dialysis are full. The company's new Bloomington facility has 12 nocturnal dialysis slots.

Another local provider, Fresenius Medical Care, has seen an increase in interest in nocturnal dialysis. Its Danville center has 10 beds, while the Circle City center near Methodist Hospital has 20. Early next year, the Circle City site will start offering another nighttime shift with 20 additional slots.

Across the country, about 2,800 patients on dialysis receive their treatments overnight. Of those, about 1,000 are DaVita patients, said Robert Provenzano, vice president of medical affairs at DaVita.

"We find that nighttime spots fill up fairly rapidly," he said.

Dushun Sanders, 40, was on daytime dialysis about 13 years before he started nocturnal dialysis at DaVita's Westside center. On a recent evening, he curled up in his chair and surfed the cable channels.

"Here, you can sleep at night and, during the day, you can take care of your business and do whatever you have to do," he said.

Switching to a nocturnal schedule has improved the condition of patients who frequently missed appointments, which detracted from their health, said Dan Viaches, DaVita operations director in Central Indiana.

Also, DaVita has tracked how its patients on nocturnal dialysis do and found that their blood pressure and anemia improve, they do better metabolically and they keep less excess water on their body, Provenzano said. In addition, they experience markedly less metabolic bone disease.

Most of these are likely due to the fact that a nocturnal dialysis regimen can nearly double the number of hours of treatment a week, Provenzano said.

Jackie Zeimmer, 62, said switching to nocturnal dialysis has made a world of difference for her. Daytime dialysis left her feeling too sick to converse with her family.

"I heard about nocturnal dialysis, that it was gentle to the body. I thought I'd try it, and I'm so glad I did," she said. "It's a godsend."

As for college student Malone, the switch to night dialysis has given him hope and new goals. Now, he dreams of having a kidney transplant and starting his own company -- perhaps in medical supplies to help others like him.

The Victor Malone of today is nothing like his former self, he said:

"It's like night and day."

http://www.indystar.com/article/20091227/LOCAL18/912270364/More-find-nighttime-is-the-right-time-for-dialysis