The London Daily/Nocturnal Hemodialysis Study--study design, morbidity, and mortality results.
BACKGROUND
Despite the growing interest in more frequent hemodialysis (HD), to date, there have been no randomized prospective studies comparing outcomes in patients dialyzed using conventional thrice-weekly therapy with either the short hours daily or long slow nocturnal HD modalities.


METHODS
The London Daily/Nocturnal Hemodialysis Study, a prospective, comparative, nonrandomized study, directly compared outcomes of quotidian HD patients with conventional thrice-weekly HD patients. Patients were assigned to either daily HD (n = 11) or nocturnal HD (n = 12) and followed up for 5 to 36 months; all data were directly compared with matched control patients receiving conventional HD. This report describes the study design, morbidity and mortality results, and vascular access results.


RESULTS
There were no significant differences between patient groups in total numbers of hospital admissions or hospital days. Likewise, there was no significant difference in number of emergency visits per patient-year. There were 3 patient deaths in each of the nocturnal HD and control groups, although none of the deaths was deemed related to HD treatment. No deaths occurred in the daily HD group. Vascular access differences between study groups were not statistically significant. Among patients with arteriovenous (AV) fistulae, more than 80% of daily HD and nocturnal HD patients elected to use the buttonhole technique and successfully performed quotidian HD through their buttonhole at the 18-month follow-up. Patients with AV fistulae had the lowest annual rates of access complications and interventions. The annual access infection rate for quotidian HD patients using catheters decreased significantly after patients switched from in-center conventional HD to more frequent HD treatments at home.


CONCLUSIONS
Results from this comprehensive and pioneering study support the hypothesis that quotidian HD is more physiological than conventional HD and results in better patient outcomes.
Lindsay
Robert M
RM
The Optimal Dialysis Research Unit, London Health Sciences Centre, London, Ontario, Canada. robert.lindsay@lhsc.on.ca
Leitch
Rosemary
R
Heidenheim
A Paul
AP
Kortas
Claude
C
D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D002408:Catheters, Indwelling; D005260:Female; D005500:Follow-Up Studies; D006437:Hemodialysis, Home / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011446:Prospective Studies; D012107:Research Design; D016896:Treatment Outcome