Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life: a randomized controlled trial.
BACKGROUND
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.


METHODS
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.


METHODS
Participants were randomly assigned in a 1:1 ratio to receive nocturnal hemodialysis 6 times weekly or conventional hemodialysis 3 times weekly.


METHODS
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.


CONCLUSIONS
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.


BACKGROUND
isrctn.org Identifier: ISRCTN25858715.
Culleton
Bruce F
BF
Department of Medicine, University of Calgary, Calgary, Alberta, Canada. bruce_culleton@baxter.com
Walsh
Michael
M
Klarenbach
Scott W
SW
Mortis
Garth
G
Scott-Douglas
Narine
N
Quinn
Robert R
RR
Tonelli
Marcello
M
Donnelly
Sarah
S
Friedrich
Matthias G
MG
Kumar
Andreas
A
Mahallati
Houman
H
Hemmelgarn
Brenda R
BR
Manns
Braden J
BJ
D000328:Adult; D000368:Aged; D000740:Anemia; D001794:Blood Pressure; D002130:Calcium Phosphates / Q000378:metabolism; D002940:Circadian Rhythm; D004921:Erythropoietin / Q000097:blood; D005260:Female; D006400:Hematocrit; D006801:Humans; D017379:Hypertrophy, Left Ventricular; D007676:Kidney Failure, Chronic / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000378:metabolism; D011788:Quality of Life; D006435:Renal Dialysis
D002130:Calcium Phosphates; D010281:Parathyroid Hormone; D004921:Erythropoietin; C020243:calcium phosphate