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Frequent nocturnal dialysis improves LV mass and QOL
19 September 2007
MedWire News: Delivering hemodialysis in six nightly sessions rather than three daytime sessions improves clinical outcomes including left ventricular (LV) mass, a preliminary trial has shown.
Morbidity and mortality in dialysis patients remains high as a result of treatment-associated complications that may worsen LV function and promote progression of vascular disease.
In this study, Bruce Culleton (University of Calgary, Alberta, Canada) and co-authors investigated claims that nocturnal hemodialysis is superior to standard therapy, as suggested in recent case-control and cohort studies.
Fifty-two patients with end-stage renal disease (ESRD) were randomly assigned to receive nocturnal dialysis six times per week or conventional dialysis three times per week.
At the end of the 6-month study period, LV mass decreased by 13.8 grams over baseline in the nocturnal group but increased by 1.5 g in the control group. This difference was highly significant (p=0.04).
Nocturnal hemodialysis was associated with other benefits, including improved quality of life, reduced use of antihypertensive drugs and calcium supplements, and reduced systolic blood pressure.
Nocturnal and conventional dialysis were comparable with respect to safety, however, with no difference in hospitalization or complication rates.
In their discussion, Culleton et al say that this is the only completed randomized controlled trial of frequent nocturnal dialysis in patients with ESRD and shows the method has advantages over conventional dialysis.
"It is unlikely that future studies will be powered to detect differences in clinical outcomes such as mortality," they admit. Cost analyses are planned alongside this clinical trial."
In an accompanying editorial, Alan Kliger (Yale University, New Haven, CT) said the trial is "important for nephrology" and concluded that "nocturnal hemodialysis may help improve the high morbidity and mortality of North American dialysis patients."
