Nocturnal Dialysis: A Better Way to Kidney Health

Nocturnal Dialysis: A Better Way to Kidney Health
By Serena Gordon
HealthDay Reporter

FRIDAY, June 20 (HealthDay News) — While dialysis is a lifesaving treatment for many people with kidney disease, it can be very inconvenient. And the process just doesn't clean the blood as effectively as well-functioning kidneys do.

But, nocturnal dialysis — a newer option — is starting to change all that.

Nocturnal dialysis, not surprisingly, is dialysis performed at night. It's usually done at home, though some people opt for in-center nighttime treatments. The big benefit to nocturnal dialysis is that the blood is filtered for about eight hours at a time, instead of the standard two-and-a-half to three hours. And, because it's usually done at home, it can be performed more frequently than the usual three times weekly.

"One of the major problems with dialysis done in the traditional sense is that it tries to provide a lot of therapy in a short period of time, and it's difficult to clear toxins and fluid in that time," said Dr. Dylan Steer, a nephrologist with Scripps Memorial Hospital in La Jolla, Calif. "Nocturnal dialysis provides a greater amount of toxin removal over a long period of time."

Dr. Robert Provenzano, chairman of the department of nephrology at St. John Hospital in Detroit, added: "The advantage of nighttime dialysis is that if you add the hours up, you get more dialysis delivered. Weekly, you get between 10 and 12 hours on regular dialysis, but on nighttime [dialysis] you get about 24. The blood is cleaner, and a lot of the restrictions placed on dialysis patients are lessened. They often use less medicine and can have a more liberal diet. The more dialysis, the better."

Normally functioning kidneys filter about 200 quarts of fluid each day, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases. All that filtering produces about two quarts of waste and some excess water. If the kidneys can't filter the fluid, waste products build up, making you ill.

Dialysis machines attempt to artificially do the work of your kidneys. Some of your blood is removed from your body and filtered through the dialysis machine, which removes toxins from the blood before returning it to your body.

Normally, people travel to a dialysis center and spend about three-and-a-half hours hooked up to the dialysis machine three times a week, usually during the day.

Recently, some centers have begun to offer nocturnal dialysis. Instead of coming during the day, patients arrive in the evening and are "dialyzed" for about eight hours while they sleep at the center, usually three times a week.

Another alternative is at-home nocturnal dialysis. At-home dialysis is an option for many people, according to Provenzano, who added that many of his patients who've chosen this option tell him they wish they'd started at-home dialysis sooner.

"The machines are much smaller, and all you have to do is plop a cartridge in. It's much less complicated than it used to be," he said.

The benefits to nighttime dialysis are clear. A recent study in the Journal of the American Medical Association found that nocturnal dialysis improved the heart health of dialysis patients, reduced the need for some blood pressure medications, and improved quality of life.

"Dialysis patients need to know that nocturnal dialysis is one of a number of options that they have for their dialysis," Steer said.

Both Steer and Provenzano said they haven't had any problems getting insurers to cover nocturnal dialysis.

"This is available. It's something patients can do themselves that improves the amount of delivered dialysis, and patients do fantastic on it," Provenzano said.

SOURCES: Robert Provenzano, M.D., chairman, department of nephrology, St. John Hospital, Detroit; Dylan Steer, M.D., nephrologist, Scripps Memorial Hospital, La Jolla, Calif.; Sept. 19, 2007, Journal of the American Medical Association

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