title: Nightly home hemodialysis: five and one-half years of experience in Lynchburg, Virginia.
abstract: BACKGROUND
  Lynchburg Nephrology Dialysis Incorporated initiated a nightly home hemodialysis (NHHD) program in September 1997. As of April 30, 2003, 40 patients had completed training; 28 patients were at home and 2 patients were in training. The average age of the patients at the initiation of the home-based therapy was 50 years, with a range of 23 to 81 years. There have been 24,239 treatments at home with a total of 84.86 patient-years on NHHD, the longest patient for 66.7 months and the shortest for 1 month.
  
  
  METHODS
  Patients dialyzed using the Fresenius 2008H machine, 6 to 10 hr, 5 to 6 nights per week. Treatment parameters included a blood flow rate of 200 to 250 mL/min; a dialysis flow rate of 200 to 300 mL/min; and a standard dialysis solution with 2.0 mEq/L potassium, 3.0 to 3.5 mEq/L calcium concentrations, 35 mEq/L HCO(3), and 140 mEq/L sodium. The longitudinal data of each patient in the program for 1, 2, 3, 4, and 5 years were compared to the same patient's pre-NHHD data. There were 25 patients in the program for 1 year, 19 patients for 2 years, 14 patients for 3 years, 6 patients for 4 years, and 4 patients for 5 years.
  
  
  RESULTS
  Statistically significant improvement occurred in all five groups' need for antihypertensive medications and phosphate binders, SF36 scores, calcium/phosphorus product, blood pressure, number of hospital admissions, and number of days of stay in the hospital. The mortality rate was 2.4% deaths per patient-year with a 95% confidence interval of 0.9% to 9.4%.
  
  
  CONCLUSIONS
  In a longitudinal study, NHHD showed significant improvements in patient secondary outcomes. The improvement in these secondary outcomes was associated with an improvement in mortality rate.
authors.affiliation: Lynchburg Nephrology Dialysis, Inc., Lynchburg, Virginia, U.S.A. rlockridge@lynchburgnephrology.com
authors.forename: Robert S
authors.initials: RS
authors.lastname: Lockridge
authors.forename: Maureen
authors.initials: M
authors.lastname: Spencer
authors.forename: Viola
authors.initials: V
authors.lastname: Craft
authors.forename: Mary
authors.initials: M
authors.lastname: Pipkin
authors.forename: Dolores
authors.initials: D
authors.lastname: Campbell
authors.forename: Lesley
authors.initials: L
authors.lastname: McPhatter
authors.forename: Jeanette
authors.initials: J
authors.lastname: Albert
authors.forename: Helen
authors.initials: H
authors.lastname: Anderson
authors.forename: Floyd
authors.initials: F
authors.lastname: Jennings
authors.forename: Terry
authors.initials: T
authors.lastname: Barger