title: Quality of life and alternate nightly nocturnal home hemodialysis.
abstract: Hemodialysis has been associated with reduced quality of life (QOL). Small cohort studies of quotidian hemodialysis regimens suggest general QOL and dialysis-related symptoms may improve compared with conventional regimens. An observational cohort study was conducted on 63 patients (age 51.7 +/- 12.9 years; 79.4% male; 33.3% diabetes; duration of renal replacement therapy 1.9 [0.7-6.4] years) converted from conventional home hemodialysis (3-5 sessions weekly, 3-6 h/session) to home nocturnal home hemodialysis (NHD) (3-5 sessions weekly, 6-10 h/session). Kidney Disease Quality of Life (KDQOL) and Assessment of Quality of Life instruments and 6-minute-walk tests were applied at baseline and 6 months. Baseline and 6 month surveys were returned by 70% of patients. On KDQOL, significant improvements in general health (P=0.02) and overall health ratings (P=0.0008), physical function (P=0.003), physical role (P=0.018), and energy and fatigue (P=0.027) were documented. There was a trend toward improvement in burden of kidney disease (P=0.05) and emotional role (P=0.066). There was a significant improvement in distance covered in the 6-minute-walk test from 513 m (420.5-576.4) to 536.5 m (459-609), P=0.007. On Assessment of Quality of Life, there was a trend toward improvement in overall utility score from 0.65 (0.39-0.81) to 0.73 (0.46-0.86), P=0.096. After 86.2 patient-years of observation, 23 patients have discontinued NHD (12 transplanted, 5 deceased, 4 psychosocial problems, 1 dialysis access problem, 1 medically unsuitable). Nocturnal home hemodialysis is a sustainable therapy. In addition to improving general QOL, alternate nightly NHD can significantly improve physical functioning as measured by KDQOL and 6-minute-walk tests.
authors.affiliation: Department of Nephrology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland 4102, Australia. carolynvaneps@optusnet.com.au
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Van Eps
authors.forename: Janine K
authors.initials: JK
authors.lastname: Jeffries
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Scott B
authors.initials: SB
authors.lastname: Campbell
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Isbel
authors.forename: David W
authors.initials: DW
authors.lastname: Mudge
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
mesh_terms: D002940:Circadian Rhythm; D015331:Cohort Studies; D005260:Female; D006437:Hemodialysis, Home / Q000379:methods* / Q000523:psychology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires