title: Effect of alternate night nocturnal home hemodialysis on anemia control in patients with end-stage renal disease.
abstract: Nocturnal home hemodialysis (NHHD) has shown promising results in various clinical parameters. Whether NHHD provide benefit in anemia management remains controversial. This study aims to investigate whether anemia and erythropoiesis-stimulating agent (ESA) requirement are improved in patients receiving alternate night NHHD compared with conventional hemodialysis (CHD). In this retrospective controlled study, a clinical data of 23 patients receiving NHHD were compared with 25 in-center CHD patients. Hemoglobin level, ESA requirement, iron profile, and dialysis adequacy indexes were compared between the two groups. Hemoglobin level increased from baseline of 9.37 ± 1.39 g/dL to 11.34 ± 2.41 g/dL at 24 months (P < 0.001) and ESA requirement decreased from 103.44 ± 53.55 U/kg/week to 47.33 ± 50.62 U/kg/week (P < 0.001) in NHHD patients. ESA requirement further reduced after the first year of NHHD (P = 0.037). Standard Kt/V increased from baseline of 2.02 ± 0.28 to 3.52 ± 0.30 at 24 months (P < 0.001). At 24 months, hemoglobin level increased by 1.98 ± 2.74 g/dL in the NHHD group while it decreased by 0.20 ± 2.32 g/dL in the CHD group (P = 0.007). ESA requirement decreased by 53.49 ± 55.50 U/kg/week in NHHD patients whereas it increased by 16.22 ± 50.01 U/kg/week in CHD patients (P < 0.001). Twenty-six percent of NHHD patients were able to stop ESA compared with none in the CHD group. Standard Kt/V showed greater increase in the NHHD group. (1.49 ± 0.36 in NHHD vs. 0.18 ± 0.31 in CHD, P = 0.005). NHHD with an alternate night schedule improves anemia and reduces ESA requirement as a result of enhanced uremic clearance. This benefit extended beyond the first year of NHHD.
authors.affiliation: Division of Nephrology, Jockey Club Nephrology and Urology Centre, Princess Margaret Hospital, Hong Kong, Hongkong.
authors.forename: Clara K Y
authors.initials: CK
authors.lastname: Poon
authors.forename: Hon-Lok
authors.initials: HL
authors.lastname: Tang
authors.forename: Joseph H S
authors.initials: JH
authors.lastname: Wong
authors.forename: Wai-Ping
authors.initials: WP
authors.lastname: Law
authors.forename: Chung-Man
authors.initials: CM
authors.lastname: Lam
authors.forename: Ka-Fai
authors.initials: KF
authors.lastname: Yim
authors.forename: Au
authors.initials: A
authors.lastname: Cheuk
authors.forename: William
authors.initials: W
authors.lastname: Lee
authors.forename: Ka-Foon
authors.initials: KF
authors.lastname: Chau
authors.forename: Matthew K L
authors.initials: MK
authors.lastname: Tong
authors.forename: Samuel K S
authors.initials: SK
authors.lastname: Fung
mesh_terms: D000328:Adult; D000740:Anemia / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006397:Hematinics / Q000008:administration & dosage*; D006437:Hemodialysis, Home; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged
chemical_list: D006397:Hematinics; D006454:Hemoglobins
keywords: Anemia; dialysis adequacy; end-stage renal disease; erythropoietin-stimulating agent; nocturnal home hemodialysis