title: A 4-month programme of in-centre nocturnal haemodialysis was associated with improvements in patient outcomes.
abstract: BACKGROUND
  Extended periods of haemodialysis (HD) can improve patient outcomes. In-centre nocturnal haemodialysis (INHD) should be explored as a method of offering extended periods of HD to patients unsuitable for or unable to perform home therapy.
  
  
  METHODS
  Ten self-selecting, prevalent HD patients started an INHD programme to assess feasibility and patient satisfaction. Quality-of-life (QOL) measures were evaluated at enrolment and after 4 months of INHD using the EQ-5D, the Hospital Anxiety and Depression Scale (HADS) and the SF-12 questionnaires. Demographic, biochemical and haematological data and data on dialysis adequacy were collected before starting INHD and after 4 months.
  
  
  RESULTS
  Three of the 10 patients failed to complete the 2-week run-in period. Seven patients completed the 4-month programme, with mean dialysis time of 355 ± 43.92 min throughout the period. The EQ-5D visual analogue score improved from 48 ± 16.89 to 72 ± 13.2 (P = 0.003) and the HADS anxiety score decreased from 9 ± 5.83 to 3.57 ± 3.04 (P = 0.029). The urea reduction ratio improved from 71.57 ± 2.29% to 80.43 ± 3.101% (P < 0.001), with improvements in phosphate control, reducing to within the target range from 1.73 ± 0.6 to 1.2 ± 0.2 (P = 0.08). Ultrafiltration (UF) volumes increased during the study from 2000 ± 510 to 2606 ± 343 mL (P = 0.015); there was a significant reduction in mean UF rate adjusted for body weight from 6.47 ± 1.71 to 4.61 ± 1.59 mL/kg/h (P = 0.032). Sensitivity analyses confirmed the significance of these results.
  
  
  CONCLUSIONS
  This single-centre study showed a 4-month programme of extended hours INHD is safe and associated with improvements in QOL measures, decreased UF rates and measures of dialysis adequacy. These data have been used to expand our service and inform the design of future randomized controlled trials to examine medical endpoints.
authors.affiliation: John Walls Renal Unit , Leicester General Hospital , Leicester , UK ; Department of Infection, Immunity and Inflammation , University of Leicester , Leicester , UK.
authors.forename: Matthew P M
authors.initials: MP
authors.lastname: Graham-Brown
authors.affiliation: John Walls Renal Unit , Leicester General Hospital , Leicester , UK ; Department of Infection, Immunity and Inflammation , University of Leicester , Leicester , UK.
authors.forename: Darren R
authors.initials: DR
authors.lastname: Churchward
authors.affiliation: John Walls Renal Unit , Leicester General Hospital , Leicester , UK ; Department of Infection, Immunity and Inflammation , University of Leicester , Leicester , UK.
authors.forename: Alice C
authors.initials: AC
authors.lastname: Smith
authors.affiliation: John Walls Renal Unit , Leicester General Hospital , Leicester , UK ; Department of Infection, Immunity and Inflammation , University of Leicester , Leicester , UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Baines
authors.affiliation: John Walls Renal Unit , Leicester General Hospital , Leicester , UK ; Department of Infection, Immunity and Inflammation , University of Leicester , Leicester , UK ; Department of Cardiovascular Science , NIHR Leicester Cardiovascular Biomedical Research Unit , Leicester , UK.
authors.forename: James O
authors.initials: JO
authors.lastname: Burton
keywords: QOL; dialysis; in-centre; nocturnal; ultrafiltration rate