PDI 2009 ISDP LAC
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Perit Dial Int 27(6): 669-674 2007
© 2007 International Society for Peritoneal Dialysis
This Article
Right arrow Full Text (PDF)
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Wong, J. H.S.
Right arrow Articles by Chan, C. T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Wong, J. H.S.
Right arrow Articles by Chan, C. T.

Clinical

THE USE OF NOCTURNAL HOME HEMODIALYSIS AS SALVAGE THERAPY FOR PATIENTS EXPERIENCING PERITONEAL DIALYSIS FAILURE

Joseph H.S. Wong1, Andreas Pierratos2, Dimitrios G. Oreopoulos3, Reem Mohammad3, Fatima Benjamin-Wong3 and Christopher T. Chan3

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

{diamondsuit} 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.

{diamondsuit} 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.

{diamondsuit} 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.

{diamondsuit} 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.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Multimed Inc. logo
Copyright © 2007 by Multimed Inc.