overnight vs 3-4 hr dialysis- input please

[GrammasGirl]

So, I called gramma's dialysis center to first see if the daily dialysis at 1-2 hrs was available over the thrice weekly 3-4 hour sessions that leave her so exhausted and nauseaous....nope- not available, so no use fighting her dump Neph. over it....his response anyway was, "Some of my patients have said it is helpful to them to go more often, but I have no medical proof that it does help"

WTF is that?! No *medical* proof?! Your PATIENTS just told you first hand that it was easier on them! What other proof do you need?! ( and you have a license to practice medicine? Guess you skipped Personality 101, Human Suffering 101 and must have been absent the day they handed out Empathy certificates!   ...ah! That felt good! )

 

Ah, hem....anyway, so I am told there is a nearby night clinic available for overnight dialysis...I was told it is easier on the patient to have SLOW dialysis over 6 hours.....research time is precious so I wanted to get first hand opinions here before I open the new can of worms for everyone and go balls out trying to get this accomplished for Gramma!

Is it easier? Are you less nauseaous? (how do you spell that word?!) Are you less exhausted? how does it effect your quality of life, sleeping away from home 3 days a week? Anything else I should consider?




TOPIC MOVED - to appropriate section - Bajanne, Moderator

[del]

nocturnal dialysis is easier on your system. My hubby does it but he does it at home 5 nights a week for 7 hours each time.  it is much more gentle on your system.  There is only a slim chance of your blood pressure dropping during treatment and you can have a much better diet and less fluid restrictions.  There are some people on here though who go to the hospital 3 nights a week for nocturnal.

[Zog]

Our toddler may have to disagree with the no known medical benefits for daily dialysis...

There is a guy that goes to our center overnight and keeps a blog of his experiences with incenter nocturnal.  Some good, mostly bad, but don't let that scare you.

His blog url is http://toastie.st

[monrein]

I haven't done nocturnal personally but there is good medical evidence that it is superior to shorter sessions.  If you do an advanced search of IHD, using the words "nocturnal dialysis" you'll get several threads and articles about the benefits.  If I had to be on D for any length of time, I'd definitely be trying for nocturnal.

[natnnnat]

Odd reply.  They  might just want you to go away.  It's not hard to find research suggesting the benefits of more frequent dialysis.  I've done a very quick search and thrown some results here, if they find problems with these or want more recent papers, I'd be glad to find others by going into the bigger medical databases... this search was just via google scholar
hope this helps
n

This first one has some cute quotes,

Scribner, B. H. and D. G. Oreopoulos (2002). "The Hemodialysis Product (HDP): A Better Index of Dialysis Adequacy than Kt/V." Dialysis & Transplantation 31(1).
   http://www.therenalnetwork.org/qi/resources/HDP.pdf
p.13:  Short hemodialysis sessions have great appeal only to the uninformed dialysis patient and to for-profit dialysis centers.
p 15:  For experienced dialysis patients who have had a high enough dose of dialysis to really regain a sense of well-being— such as those with an HDP above 70—“how they feel” is the simplest, most reliable guide of all.

I suggest you cut the quotes off before presenting them to your centre however, might not help to suggest that they have financial motivations...



Blair, D. (2008). "More frequent dialysis has benefit." Renal & Urology News Nov 1, 2008.
   http://www.renalandurologynews.com/more-frequent-dialysis-has-benefit/article/121388/
Short daily or nocturnal hemodialysis improves nutrition better than conventional hemodialysis

Culleton, B. F., M. Walsh, et al. (2007). "Effect of Frequent Nocturnal Hemodialysis vs Conventional Hemodialysis on Left Ventricular Mass and Quality of Life: A Randomized Controlled Trial." JAMA 298(11): 1291-1299.
   http://jama.ama-assn.org/cgi/content/abstract/298/11/1291
Context Morbidity and mortality rates in hemodialysis patients remain excessive. Alterations in the delivery of dialysis may lead to improved patient outcomes.
Objective To compare the effects of frequent nocturnal hemodialysis vs conventional hemodialysis on change in left ventricular mass and health-related quality of life over 6 months. Design, Setting, and Participants A 2-group, parallel, randomized controlled trial conducted at 2 Canadian university centers between August 2004 and December 2006. A total of 52 patients undergoing hemodialysis were recruited. Intervention Participants were randomly assigned in a 1:1 ratio to receive nocturnal hemodialysis 6 times weekly or conventional hemodialysis 3 times weekly. Main Outcome Measures The primary outcome was change in left ventricular mass, as measured by cardiovascular magnetic resonance imaging. The secondary outcomes were patient-reported quality of life, blood pressure, mineral metabolism, and use of medications. Results Frequent nocturnal hemodialysis significantly improved the primary outcome (mean left ventricular mass difference between groups, 15.3 g, 95% confidence interval [CI], 1.0 to 29.6 g; P = .04). Frequent nocturnal hemodialysis did not significantly improve quality of life (difference of change in EuroQol 5-D index from baseline, 0.05; 95% CI, -0.07 to 0.17; P = .43). However, frequent nocturnal hemodialysis was associated with clinically and statistically significant improvements in selected kidney-specific domains of quality of life (P = .01 for effects of kidney disease and P = .02 for burden of kidney disease). Frequent nocturnal hemodialysis was also associated with improvements in systolic blood pressure (P = .01 after adjustment) and mineral metabolism, including a reduction in or discontinuation of antihypertensive medications (16/26 patients in the nocturnal hemodialysis group vs 3/25 patients in the conventional hemodialysis group; P < .001) and oral phosphate binders (19/26 patients in the nocturnal hemodialysis group vs 3/25 patients in the conventional dialysis group; P < .001). No benefit in anemia management was seen with nocturnal hemodialysis.
Conclusion This preliminary study revealed that, compared with conventional hemodialysis (3 times weekly), frequent nocturnal hemodialysis improved left ventricular mass, reduced the need for blood pressure medications, improved some measures of mineral metabolism, and improved selected measures of quality of life.
Trial Registration isrctn.org Identifier: ISRCTN25858715

Schiffl, H., S. M. Lang, et al. (2002). "Daily Hemodialysis and the Outcome of Acute Renal Failure." The New England Journal of Medicine 346(5): 305-310.
   http://www.contentnejmorg.zuom.info/cgi/content/abstract/346/5/305
Background Intermittent hemodialysis is widely used as renal-replacement therapy in patients with acute renal failure, but an adequate dose has not been defined. We performed a prospective study to determine the effect of daily intermittent hemodialysis, as compared with conventional (alternate-day) intermittent hemodialysis, on survival among patients with acute renal failure.
Methods A total of 160 patients with acute renal failure were assigned to receive daily or conventional intermittent hemodialysis. Survival was the primary end point of the study. The duration of acute renal failure and the frequency of therapy-related complications were secondary end points.
Results The two study groups were similar with respect to age, sex, cause and severity of acute renal failure, medical or surgical intensive care setting, and the score on the Acute Physiology, Age, and Chronic Health Evaluation. Daily hemodialysis resulted in better control of uremia, fewer hypotensive episodes during hemodialysis, and more rapid resolution of acute renal failure (mean [±SD], 9±2 vs. 16±6 days; P=0.001) than did conventional hemodialysis. The mortality rate, according to the intention-to-treat analysis, was 28 percent for daily dialysis and 46 percent for alternate-day dialysis (P=0.01). In a multiple regression analysis, less frequent hemodialysis (on alternate days, as opposed to daily) was an independent risk factor for death.
Conclusions The high mortality rate among critically ill patients with acute renal failure who require renal-replacement therapy is related to both coexisting conditions and uremic damage to other organ systems. Intensive hemodialysis reduces mortality without increasing hemodynamically induced morbidity.

Raj, D. S. C., B. Charra, et al. (1999). "In search of ideal hemodialysis: Is prolonged frequent dialysis the answer?" American journal of kidney diseases : the official journal of the National Kidney Foundation 34(4): 597-610.
   http://www.ajkd.org/article/S0272-6386%2899%2970382-3/abstract
Advances in technology have made it possible to deliver a high Kt/V in a shorter time. The realization that duration of dialysis may be an important predictor of survival independent of dialysis dose has resulted in the popularity of prolonged slow dialysis (PHD). The longer duration and increased frequency of dialysis achieve excellent small- and middle-molecular weight solute clearance and also attenuate the peak concentration of uremic toxins. The slow dialysis process enables the equilibration of tissue and vascular compartments, resulting in better clearance and decreased postdialysis rebound increase in solutes. Gentle, persistent ultrafiltration allows the control of hypertension with minimal antihypertensive use. The intense and more frequent dialysis improves appetite and permits liberalization of diet. This greater dietary protein intake results in a progressive increase in serum albumin level and dry weight. Nocturnal hemodialysis achieves control of hyperphosphatemia without phosphate binders and a significant reduction in serum β2 -microglobulin levels. Normalization of extracellular volume, better clearance of uremic toxins, and improved nutrition result in a significant improvement in survival. The flexible time schedule with home hemodialysis and improvement of sleep and neurocognitive function allow better rehabilitation. The available evidence indicates PHD may be closer to the concept of an ideal dialysis, but there is lingering uncertainty about the consequence of prolonged immune stimulation, catabolism, and loss of essential solutes with these therapies.


Woods, J. D., F. K. Port, et al. (1999). "Clinical and biochemical correlates of starting 'daily' hemodialysis." Kidney Int 55(6): 2467-2476.
   http://www.nature.com/ki/journal/v55/n6/abs/4490824a.html
Clinical and biochemical correlates of starting "daily" hemodialysis.
Background
Daily hemodialysis has been proposed to improve outcomes for patients with end-stage renal disease. There has been increasing evidence that daily hemodialysis might have potential advantages over intermittent dialysis. However, despite these potential advantages, daily hemodialysis is infrequently used in the United States, and published accounts on the technique are few.
Methods
We describe patient outcomes after increasing their hemodialysis frequency from three to six times per week in a cohort of 72 patients treated at nine centers during 1972 to 1996. Analyses of predialysis blood pressure and laboratory parameters from 6 months before until 12 months after starting frequent hemodialysis used a repeated-measures statistical technique.
Results
Predialysis systolic and diastolic blood pressures fell by 7 and 4 mm Hg, respectively, after starting frequent hemodialysis (P = 0.02). Reductions were greatest among patients being treated with antihypertensive medications, despite a reduction in their dosage of medications. Postdialysis weight fell by 1.0% within one month of starting frequent hemodialysis and improved control of hypertension. After the initial drop, postdialysis weight increased at a rate of 0.85 kg per six months. Serum albumin rose by 0.29 g/dl (P < 0.001) between months 1 to 12 of treatment with daily hemodialysis. Hematocrit rose by 3.0 percentage points (P = 0.02) among patients (N = 56) not treated with erythropoietin during this period. Two years after the start of daily hemodialysis, Kaplan–Meier analyses showed a patient survival of 93%, a technique survival of 77%, and an arteriovenous fistula patency of 92%. Vascular access patency was excellent despite more frequent use of the access.
Conclusions
These results suggest that in certain patients, daily hemodialysis might have advantages over three times per week hemodialysis.

[natnnnat]

There's a useful table on this one

Scribner, B. H. and D. G. Oreopoulos (2002). "The Hemodialysis Product (HDP): A Better Index of Dialysis Adequacy than Kt/V." Dialysis & Transplantation 31(1).
   http://www.therenalnetwork.org/qi/resources/HDP.pdf

which, by the way, you can get to as PDF via that link, its free

[peleroja]

I know you're talking hemo, and I am on nocturnal PD, but I feel a whole lot better on PD than I ever did on hemo.  I do believe that longer, slower is much more beneficial for the system.

[kitkatz]

First hand experience: I love doing nocturnal dialysis over 3 to four hours three days a week. The fuzzy headedness cleared up and my sense of humor has come back finally.  I feel better and my personality has changed. I did nine and a half years of three days a week for four hours, The last two years have been great on nocturnal.  I feel good and am much better physically.

[rsudock]

kit kat do you do in center or at home?

[Desert Dancer]

grammasgirl, I've been doing nocturnal for about five weeks now and I feel better than I've felt in years. My energy has come back, I have an appetite (something I never had before, even in my healthiest days) and the fog has started to lift. Also - since I dialyze while I sleep - I have all my waking hours to myself and could conceivably work a full-time job. I've also been able to discontinue taking my phosphorus binders and my diet and fluid are not restricted at all. There are so many benefits to long, slow dialysis... I could be here all day. I don't think it's a decision your gramma would ever regret.

[thegrammalady]

i do nocturnal, in center, 7 hours, 3 nights a week. i'm off all blood pressure meds, all binders. i eat and drink pretty much what i want. occasionally i have trouble sleeping, but most nights not at all. my center has been doing this for 2 years. i was the first one with my hand in the air, take me, me, me..... i wouldn't go back to days for anything. the only time i do is when i travel. the small town my family lives in doesn't have nocturnal. last year i did a month of days with no problems.  i enjoy feeling normal instead of sick.

[dyannalw]

I just started nocturnal on Sunday. I am on for 6 hours and really like it so far. I don't go home feeling exhausted like before, I have not gone home with a headache. I hope this continues. I like the idea of less diet and fluid restrictions. My clinic just started the nocturnal shift Sunday so it is all new to everyone including the staff.

[tyefly]

they only let you do 6 hours.....    you cant do 7 or 8   ??   hard to get sleep with only 6 hours.....   are you still tired afterwards.....

Glad to see you doing nocturnal   ....

[kitkatz]

I do eight hours, but only sleep six of them usually.

[Bruno]

I think that the more dialysis hours you can do each week the easier it is on your body and the better the result (I'm talking home haemo).
If your kidneys were normal they would work 7/24 so 3 x 5 hour sessions are minimal and 4 x 6 hour sessions must be better, but that is still only 24 hours per week.
The problem is that there is a limit to what you can get through during daylight hours and still have a life which is how we come to nocturnal.
Nocturnal lets you increase your hours per session (very good) increase your hours per week (32 is easy and excellent) and still have a life.
Take a look at Dr. John Agar's site in Geelong Australia.