Effect of switching to nocturnal thrice-weekly hemodialysis on clinical and laboratory parameters: our experience.
Long or frequent hemodialysis schedules are reported to improve clinical outcomes. We report here our experience with an in-center, nocturnal, thrice-weekly hemodialysis program. We retrospectively analyzed the effect of switching 10 patients (8 male, age 45 ± 11 years, renal replacement therapy vintage 12 ± 8 years) from regular, 4-5 h, thrice-weekly hemodialysis to 8 h nocturnal, in-center hemodialysis as regards dialysis efficiency, chronic kidney disease-metabolic and bone disease (CKD-MBD) parameters, blood pressure, and anemia. With more intense dialysis, the mean predialysis creatinine and urea decreased significantly (1092 ± 195 vs. 961 ± 154 μmol/L, P < 0.01 and 30.8 ± 4.6 vs. 25.5 ± 2.9 mmol/L, P < 0.01), while the decrease in potassium was insignificant (5.9 ± 0.7 vs. 5.6 ± 0.5 mmol/L), but in 3/10 patients, dialysate potassium was increased. Three months after starting nocturnal hemodialysis, no significant influence on pre-dialysis blood pressure was observed (143/80 vs. 140/80 mmHg), but antihypertensive medications were reduced in two patients. The mean dry weight reduced (74 ± 12 to 72 ± 12 kg) and the mean ultrafiltration increased insignificantly (3123 ± 1174 to 3434 ± 1341 mL). Serum calcium was stable, while phosphate reduced insignificantly (1.5 ± 0.5 to 1.2 ± 0.2 mmol/L), but 6/10 patients were able to discontinue phosphate binders, the dose was reduced in one, and phosphate was added to dialysate in 3/10 patients. Intact parathyroid hormone values were within the target range, except in patients post-parathyroidectomy. There were no differences in hemoglobin (121 ± 6 vs. 122 ± 8 g/L), and the mean epoetin dose decreased insignificantly (5950 ± 3947 vs. 5250 ± 4238 IU/week). To conclude, improved phosphate and potassium control and reduction in phosphate binders were observed after switching to nocturnal hemodialysis. There was an insignificant reduction of epoetin dose and antihypertensive medications.
Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia. jakob.gubensek@kclj.si
Jakob
J
Gubenšek
Jadranka
J
Buturović-Ponikvar
Bojan
B
Knap
Andreja
A
Marn Pernat
Miha
M
Benedik
Rafael
R
Ponikvar
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001851:Bone Diseases, Metabolic / Q000209:etiology / Q000503:physiopathology*; D002614:Chelating Agents / Q000008:administration & dosage; D000068256:Darbepoetin alfa; D004305:Dose-Response Relationship, Drug; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use; D011188:Potassium / Q000097:blood; D006435:Renal Dialysis / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D002614:Chelating Agents; D006454:Hemoglobins; D010710:Phosphates; C508420:continuous erythropoietin receptor activator; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D011092:Polyethylene Glycols; D011188:Potassium
Anemia; Hemodialysis; Hypertension; Metabolic and bone disease; Nocturnal; Outcome assessment; Phosphates