Nocturnal hemodialysis does not improve overall measures of quality of life compared to conventional hemodialysis.
We conducted a randomized controlled trial to compare the quality of life of 52 patients undergoing nocturnal hemodialysis and conventional hemodialysis. Quality of life was measured using a number of established methods including the Kidney Disease Quality of Life Short Form and the preference-based Euroqol EQ-5D questionnaire (whose scores varied from 0 to 1). The primary outcome was a change in the Euroqol EQ-5D index scores between baseline and 6 months. We performed additional analyses comparing change in quality of life from pre-randomization (when patients were unaware of treatment allocation) to 6 months. Other analyses considered the impact of nocturnal hemodialysis on four pre-selected Kidney Disease Quality of Life Short Form domains, and the longer term impact of nocturnal hemodialysis on quality of life. Compared with conventional hemodialysis, nocturnal hemodialysis increased Euroqol-EQ-5D index scores by 0.05, which was not significantly different from baseline. When six-month values were compared with pre-randomization values rather than baseline values, the between group difference was larger (0.12) though it was still not statistically significant (P=.06). Nocturnal hemodialysis was associated with clinically and statistically significant improvements in selected kidney-specific quality of life domains (P=.01 for effects of kidney disease; P=.02 for burden of kidney disease). Our primary quality of life analysis did not demonstrate a statistically significant change between nocturnal hemodialysis and conventional hemodialysis, though statistically significant and clinically important changes in some secondary kidney-disease- specific measures were observed.
Manns
Braden J
BJ
Department of Medicine, University of Calgary, Calgary, Alberta, Canada. braden.manns@calgaryhealthregion.ca
Walsh
Michael W
MW
Culleton
Bruce F
BF
Hemmelgarn
Brenda
B
Tonelli
Marcello
M
Schorr
Melissa
M
Klarenbach
Scott
S
D006801:Humans; D007674:Kidney Diseases / Q000628:therapy*; D009551:Night Care; D011788:Quality of Life; D006435:Renal Dialysis / Q000379:methods*; D011795:Surveys and Questionnaires; D013997:Time Factors