Alternate Night Home Hemodialysis Improves Anemia

NHHD performed every other night may be superior to NHHD performed 6 or 7 times a week.
NHHD performed every other night may be superior to NHHD performed 6 or 7 times a week.

Nocturnal home hemodialysis (NHHD) performed on alternate nights improves anemia and decreases the need for an erythropoiesis-stimulating agent (ESA) compared with conventional hemodialysis, according to a new study.

Clara K. Y. Poon, MD, of Princess Margaret Hospital in Hong Kong, and colleagues compared 23 patients receiving NHHD with 25 in-center patients receiving conventional hemodialysis (CHD). In the NHHD group, mean hemoglobin levels increased significantly from 9.37 g/dL at baseline to 11.34 g/dL at 24 months, the investigators reported online ahead of print in Hemodialysis International.

During that same period, the mean weekly ESA requirement decreased significantly from 103.4 U/kg to 47.3 U/kg. In the CHD group, mean hemoglobin levels were 9.5 g/dL at baseline and 9.3 g/dL at 24 months, a non-significant difference. The weekly ESA requirement increased significantly from 89.7 U/kg to 105.9 U/kg. In addition, 26% of the NHHD patients were able to discontinue ESA therapy compared with none of the CHD patients, according to the researchers.

The NHHD group experienced greater increase in standard Kt/V compared with the CHD group.

“NHHD with an alternate night schedule improves anemia and reduces ESA requirement as a result of enhanced uremic clearance,” the authors concluded.

Dr. Poon's team commented that NHHD on alternate nights may be superior to NHHD performed 6 or 7 times a week in terms of anemia management. They cited a cohort study in which investigators examined anemia parameters in patients receiving daily long nocturnal hemodialysis and those undergoing short daily hemodialysis and CHD.

The study, published in the American Journal of Kidney Diseases (2003;42 (S1):S18–S23), found that all patients lost a significant amount of blood in hemodialysis tubing and as a result of laboratory testing compared with baseline, the groups undergoing dailiy hemodialysis experienced a significantly greater amount of blood compared with the CHD group.

“Hence, prolonged and more frequent hemodialysis may increase total blood loss to the blood circuit and it may offset the benefits to anemia by long duration of hemodialysis,” Dr. Poon's team noted.

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