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Clinical |
Division of Nephrology,1 Queen Elizabeth Hospital, Hong Kong, China; Division of Nephrology,2 Humber Regional Hospital; Division of Nephrology,3 University Health Network, Toronto, Ontario, Canada
Correspondence to: C.T. Chan, 200 Elizabeth Street, 8N Room 842, Toronto, Ontario M5G 2C4 Canada. christopher.chan{at}uhn.on.ca
Background: Failure of peritoneal dialysis (PD) results
in poor quality of life and worsening morbidity in patients with end-stage
renal disease (ESRD). Traditionally, hospital-based conventional hemodialysis
has been the only option for this patient population. We hypothesized that
nocturnal home hemodialysis (NHD), 3 - 6 sessions per week, 6 - 8 hours per
session, is a suitable alternative salvage therapy for this vulnerable patient
group. Methods: This is a descriptive cohort study of all
consecutive ESRD patients failing PD that were converted to NHD at the
University Health Network and Humber River Regional Hospital from 2003 to
2005. Our primary objective was to describe the changes in clinical and
biochemical indices before and after conversion from PD to NHD. Results: 69 patients required transfer from PD to
another form of renal replacement therapy during the period of interest. Our
pilot cohort included 8 ESRD patients (5 males, 3 females; age 53 ± 7
years). Mean duration on PD was 4.8 ± 4.6 years. NHD delivered a higher
dose of dialysis, as reflected by lower plasma creatinine concentration 1 year
after beginning NHD (from 1107 ± 312 µmol/L with PD to 649 ±
309 µmol/L, p = 0.01) and a rise in standardized Kt/V (from 2.21
± 0.73 with PD to 4.49 ± 1.92 after 6 months of NHD, to 4.51
± 1.77 after 1 year of NHD; p < 0.001). There was a
progressive and sustained rise in plasma albumin after conversion to NHD (from
31 ± 4 g/L with PD to 36 ± 4 g/L after 6 months of NHD, to 39
± 2 g/L after 1 year of NHD; p = 0.001). Hemoglobin
concentrations increased (from 102 ± 13 to 125 ± 7 g/L,
p = 0.03), while erythropoietin requirement tended to fall (from
17500 ± 8669 to 9197 ± 7573 U/week). Plasma phosphate fell (from
2.1 ± 0.6 to 1.1 ± 0.3 mmol/L, p = 0.01) despite a
decrease in phosphate binder requirement. Blood pressure profile also tended
to improve after conversion to NHD. Conclusion: Nocturnal HD represents a promising,
viable, alternative renal replacement therapy for patients experiencing PD
failure. The clinical impact of transferring ESRD patients failing PD to NHD
deserves further investigation.
KEY WORDS: Failure on peritoneal dialysis; nocturnal home hemodialysis; home dialysis.
Received 24 November 2006; accepted 5 June 2007.
This article has been cited by other articles:
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  R. P. Pauly, J. S. Gill, C. L. Rose, R. A. Asad, A. Chery, A. Pierratos, and C. T. Chan Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients Nephrol. Dial. Transplant., September 1, 2009; 24(9): 2915 - 2919. [Abstract] [Full Text] [PDF]
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 R. P. Pauly, M. Copland, P. Komenda, A. Levin, A. Pierratos, and C. T. Chan Utility and Limitations of a Multicenter Nocturnal Home Hemodialysis Cohort Clin. J. Am. Soc. Nephrol., November 1, 2008; 3(6): 1846 - 1851. [Abstract] [Full Text] [PDF]
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