Sleepover dialysis improves quality of lifeBy JO CIAVAGLIA
phillyBurbs.com
Three mornings a week, David Smith gets up a healthier, much happier man.
His blood is cleaned of the toxins that build up between kidney treatments. Even better, he has the day free for catching a movie or food shopping, activities he once rarely enjoyed.
For more than a year, dialysis sucked up most of his day and his energy, leaving the 51-year-old Middletown man too tired to do much beyond sleeping on treatment days, a common complaint among patients with kidney failure.
What made the difference, he said, is reporting for dialysis around bedtime instead of breakfast time.
Nocturnal dialysis isn’t new, but few medical centers offer evening or overnight hours, despite mounting medical evidence suggesting longer dialysis improves patient health and quality of life.
More than 275,000 Americans with kidney failure (also called end stage renal disease) depend on dialysis for their survival, according to the National Kidney Foundation.
The kidneys are the body’s filtering system, transferring waste products and water. If they stop working, salt, toxins and excess water accumulate in the blood and can be fatal unless removed. Dialysis, which artificially performs the job, is typically ordered when a person has only 10 percent to 15 percent of kidney function left.
The technology saves lives, but it carries health risks. The annual death rate for dialysis patients is 22 percent, according to national statistics. The treatment side effects include chronic exhaustion, muscle cramping and blood pressure drops.
Conventional hemodialysis, the most common method, removes blood from the body and filters it in a machine that cleans it, removes excess fluid and pumps it back into the patient, but the two- to five-hour process done three times a week can be physically draining.
But stretching dialysis over eight hours more closely replicates normal kidney function, so it’s less stress and strain on the body. Patients report they feel better and have more ability to work, attend school or other activities during the day.
‘So much better’
Nocturnal hemodialysis is a much less common treatment, mostly associated with at-home treatment, an option where patients are trained to dialyze themselves as often as six nights a week.
Roughly 941 of the 4,666 dialysis clinics listed on the Nephron Information Center, a national online resource site, had shifts after 5 p.m. Only 50 of 225 listed Pennsylvania clinics had evening hours.
Far fewer — 137 clinics nationwide — specifically indicated they offered the longer, in-center overnight treatment; in Pennsylvania, only 15 offered it, according to the Nephron site.
DaVita St. Mary Dialysis Center in Newtown Township began its nighttime program in March following a two-year pilot in the Philadelphia-Pocono region, company administrator Lucille Enama said. It will also begin offering at-home overnight dialysis starting in August.
There are four DaVita patients in the nighttime program; the typical check-in time is 8:30 p.m. and most are released around 4:30 a.m. During the night, they can sleep (room lights are dimmed and nightlights are fixed atop machines) or watch movies.
Bristol Township resident Roberta North, 54, works the night shift as a proofreader at a publishing company. Before she started nighttime dialysis in March, she was hardly sleeping.
She’d get home at 2 a.m. and had to leave for dialysis at 5:15 a.m. She’d return home around noon and try to nap before picking up her daughter at school, then reporting to work at 4 p.m.
DaVita worked with North, who adjusted her work schedule so now she does 4½ hours of overnight dialysis twice a week, and eight hours on Sundays. She is home by 5 a.m.
"This has been so much better. I get all my sleep," North said. "I don’t know how much longer I would have lasted. It was definitely getting difficult."
Almost normal
For kidney patients, quality of life is as important as maintaining their health, said Dr. Lynda Szczech, director of nephrology research at Duke University Clinical Research Institute. She is also chairwoman of the American Society of Nephrology’s dialysis advisory group.
Anecdotal and observational evidence suggests alternatives to conventional dialysis such as nighttime dialysis reduce related symptoms such as lack of appetite, nausea and dry skin, Szczech said.
The National Institutes of Health and the Centers for Medicare and Medicaid are sponsoring the largest ongoing study comparing nocturnal dialysis patients to those on regular dialysis to determine if one method has better health outcomes, which could translate into healthcare costs savings.
Initial studies suggest that tests show nighttime patients have cleaner blood and the longer dialysis time may help prevent bone disease because calcium isn’t washed out as aggressively as conventional dialysis.
A 2005 Canadian study suggests nighttime dialysis patients may have a greater capacity to repair their hearts and blood vessels compared to those on conventional dialysis.
Chronic fluid buildup is also highly linked to heart disease, the major killer of kidney patients. Unlike standard daytime dialysis, nighttime treatment appeared to prevent the buildup of calcium phosphate within arteries — a major risk factor for heart disease in kidney patients, the study found.
The overnight dialysis is considered a better method for obese patients, who typically hold higher amounts of waste product in their blood and would benefit from longer treatment times.
Like David Smith.
Before he switched to overnight, the 4½ hours, three days a week he spent in treatment wasn’t enough time to clean all the built-up toxins and water in his 6-foot, 5-inch, 385-pound frame. As a result, most of the time he was left feeling exhausted.
"Anything was a hassle," he explained.
Now he checks in and watches movies all night, goes home and sleeps for a few hours and then has the rest of the day to do what he wants. He feels almost normal, Smith added.
"I can’t go crazy, but it’s a lot better quality of life."
Jo Ciavaglia can be reached at 215 949-4181 or jciavaglia@phillyBurbs.com.
http://www.phillyburbs.com/pb-dyn/news/292-07222007-1381360.html
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