The effects of nocturnal compared with conventional hemodialysis on mineral metabolism: A randomized-controlled trial.
Hyperphosphatemia is common among patients receiving dialysis and is associated with increased mortality. Nocturnal hemodialysis (NHD) is a long, slow dialytic modality that may improve hyperphosphatemia and disorders of mineral metabolism. We performed a randomized-controlled trial of NHD compared with conventional hemodialysis (CvHD); in this paper, we report detailed results of mineral metabolism outcomes. Prevalent patients were randomized to receive NHD 5 to 6 nights per week for 6to 10 hours per night or to continue CvHD thrice weekly for 6 months. Oral phosphate binders and vitamin D analogs were adjusted to maintain phosphate, calcium and parathyroid hormone (PTH) levels within recommended targets. Compared with CvHD patients, patients in the NHD group had a significant decrease in serum phosphate over the course of the study (0.49 mmol/L, 95% confidence interval 0.24-0.74; P=0.002) despite a significant reduction in the use of phosphate binders. Sixty-one percent of patients in the NHD group compared with 20% in the CvHD group had a decline in intact PTH (P=0.003). Nocturnal hemodialysis lowers serum phosphate, calcium-phosphate product and requirement for phosphate binders. The effects of NHD on PTH are variable. The impact of these changes on long-term cardiovascular and bone-related outcomes requires further investigation.
Walsh
Michael
M
Department of Medicine, University of Calgary, Alberta, Canada.
Manns
Braden J
BJ
Klarenbach
Scott
S
Tonelli
Marcello
M
Hemmelgarn
Brenda
B
Culleton
Bruce
B
D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D002114:Calcinosis / Q000453:epidemiology / Q000517:prevention & control; D002118:Calcium / Q000097:blood; D002130:Calcium Phosphates / Q000097:blood; D002940:Circadian Rhythm; D003131:Combined Modality Therapy; D005260:Female; D006437:Hemodialysis, Home / Q000379:methods*; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control*; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000378:metabolism* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000378:metabolism; D010281:Parathyroid Hormone / Q000378:metabolism; D010710:Phosphates / Q000097:blood; D012307:Risk Factors
D002130:Calcium Phosphates; D008903:Minerals; D010281:Parathyroid Hormone; D010710:Phosphates; C020243:calcium phosphate; D002118:Calcium