The use of nocturnal home hemodialysis as salvage therapy for patients experiencing peritoneal dialysis failure.
BACKGROUND
Failure of peritoneal dialysis (PD) results in poor quality of life and worsening morbidity in patients with end-stage renal disease (ESRD). Traditionally, hospital-based conventional hemodialysis has been the only option for this patient population. We hypothesized that nocturnal home hemodialysis (NHD), 3-6 sessions per week, 6-8 hours per session, is a suitable alternative salvage therapy for this vulnerable patient group.


METHODS
This is a descriptive cohort study of all consecutive ESRD patients failing PD that were converted to NHD at the University Health Network and Humber River Regional Hospital from 2003 to 2005. Our primary objective was to describe the changes in clinical and biochemical indices before and after conversion from PD to NHD.


RESULTS
69 patients required transfer from PD to another form of renal replacement therapy during the period of interest. Our pilot cohort included 8 ESRD patients (5 males, 3 females; age 53 +/- 7 years). Mean duration on PD was 4.8 +/- 4.6 years. NHD delivered a higher dose of dialysis, as reflected by lower plasma creatinine concentration 1 year after beginning NHD (from 1107 +/- 312 micromol/L with PD to 649 +/- 309 micromol/L, p = 0.01) and a rise in standardized Kt/V (from 2.21 +/- 0.73 with PD to 4.49 +/- 1.92 after 6 months of NHD, to 4.51 +/- 1.77 after 1 year of NHD; p < 0.001). There was a progressive and sustained rise in plasma albumin after conversion to NHD (from 31 +/- 4 g/L with PD to 36 +/- 4 g/L after 6 months of NHD, to 39 +/- 2 g/L after 1 year of NHD; p = 0.001). Hemoglobin concentrations increased (from 102 +/- 13 to 125 +/- 7 g/L, p = 0.03), while erythropoietin requirement tended to fall (from 17500 +/- 8669 to 9197 +/- 7573 U/week). Plasma phosphate fell (from 2.1 +/- 0.6 to 1.1 +/- 0.3 mmol/L, p = 0.01) despite a decrease in phosphate binder requirement. Blood pressure profile also tended to improve after conversion to NHD.


CONCLUSIONS
Nocturnal HD represents a promising, viable, alternative renal replacement therapy for patients experiencing PD failure. The clinical impact of transferring ESRD patients failing PD to NHD deserves further investigation.
Wong
Joseph H S
JH
Division of Nephrology, Queen Elizabeth Hospital, Hong Kong, China.
Pierratos
Andreas
A
Oreopoulos
Dimitrios G
DG
Mohammad
Reem
R
Benjamin-Wong
Fatima
F
Chan
Christopher T
CT
D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D006397:Hematinics / Q000008:administration & dosage; D006437:Hemodialysis, Home; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D016879:Salvage Therapy; D012709:Serum Albumin / Q000378:metabolism; D017211:Treatment Failure; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D006397:Hematinics; D006454:Hemoglobins; D012709:Serum Albumin; D004921:Erythropoietin; D003404:Creatinine