title: In-Center Nocturnal Hemodialysis Versus Conventional Hemodialysis: A Systematic Review of the Evidence.
abstract: BACKGROUND
  Owing to its longer treatment duration-up to 8 hours per dialysis treatment-in-center thrice-weekly nocturnal hemodialysis (HD) is receiving greater attention. To better understand the evidence for in-center nocturnal HD, we sought to systematically review the literature to determine the effects of in-center nocturnal HD versus conventional HD on clinically relevant outcomes.
  
  
  METHODS
  We searched MEDLINE, Embase, Evidence-Based Medicine Reviews (EBMR), Web of Science, and Scopus from the earliest date in the database to November 2016.
  
  
  METHODS
  Adults receiving in-center nocturnal HD compared with those receiving conventional HD.
  
  
  METHODS
  All quasi-experimental and observational studies were considered; randomized trials were sought but not found.
  
  
  METHODS
  Nocturnal vs conventional in-center HD.
  
  
  RESULTS
  Indexes of blood pressure and left ventricular hypertrophy, markers of anemia, measures of bone mineral metabolism, nutrition, quality of life, sleep quality, episodes of intradialytic hypotension, hospitalization, and mortality.
  
  
  RESULTS
  Of 2,086 identified citations, 21 met the inclusion criteria, comprising a total of 1,165 in-center nocturnal HD patients and 15,865 conventional HD patients. Although there was substantial heterogeneity in reporting of outcomes, we pooled data for measures of blood pressure, anemia, and mineral metabolism. Though heterogeneity was generally high, in-center nocturnal HD was associated with improved systolic blood pressure (-3.18 [95% CI, -5.58 to -0.78) mm Hg, increased hemoglobin levels (0.53 [95% CI, 0.11-0.94] g/dL), and lower serum phosphate levels (-0.97 [95% CI, -1.48 to -0.46] mg/dL).
  
  
  CONCLUSIONS
  No randomized trials have been conducted to address the clinical effects of in-center nocturnal HD. The quality of the observational literature contributing to the results of this review was generally poor to moderate. Confounded outcomes are a significant concern. Publication bias and outcome reporting bias remain possibilities.
  
  
  CONCLUSIONS
  Relative to conventional HD, in-center nocturnal HD was associated with improvements in several clinically relevant outcomes. Other benefits may not have been detected due to small sample sizes of included studies; no prespecified outcome was worse with in-center nocturnal HD.
authors.affiliation: Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, AB, Canada; Headwaters Health Care Centre, Orangeville, ON, Canada. Electronic address: bcw@ualberta.net.
authors.forename: Ben
authors.initials: B
authors.lastname: Wong
authors.affiliation: University of Manitoba, Winnipeg, MB, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Collister
authors.affiliation: Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, AB, Canada.
authors.forename: Maliha
authors.initials: M
authors.lastname: Muneer
authors.affiliation: University of Alberta Libraries, Edmonton, AB, Canada.
authors.forename: Dale
authors.initials: D
authors.lastname: Storie
authors.affiliation: Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, AB, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Courtney
authors.affiliation: Alberta Kidney Disease Network, Edmonton, AB, Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Lloyd
authors.affiliation: University of Alberta Libraries, Edmonton, AB, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Campbell
authors.affiliation: Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, AB, Canada.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Pauly
mesh_terms: D000554:Ambulatory Care Facilities; D006437:Hemodialysis, Home; D006801:Humans; D006435:Renal Dialysis / Q000379:methods; D016896:Treatment Outcome
keywords: Hemodialysis (HD); blood pressure; cardiac geometry; conventional HD; dialysis dose; dialysis modality; hospitalization; hyperphosphatemia; in-center nocturnal HD; intensive HD; intradialytic hypotension; left ventricular hypertrophy; mineral metabolism; mortality; nocturnal HD; systematic review