Nocturnal Hemodialysis Found Not to Improve Quality of Life

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It did, however, improve clinical outcomes compared with conventional hemodialysis.

Nocturnal hemodialysis (NHD) may not offer a significant improvement in patients' quality of life (QOL) compared with conventional hemodialysis (CHD), according to a new study.

Researchers enrolled 52 patients, of whom 27 were randomized to NHD and 25 to CHD. The primary outcome was a change in European Quality of Life Scale (EQ-5D) index scores between baseline and six months. At the end of the study period, there was a nonsignificant between-group difference of just 0.05 points in the change from baseline in EQ-5D index scores. Preference-based EQ-5D scores range from 0 to 1.

When six-month values were compared with prerandomization values (i.e., when patients were unaware of treatment allocation), the difference in EQ-5D scores between NHD and CHD patients was larger, but not significantly so, according to a report in Kidney International (2008;75:542-549).

The investigators also evaluated the two groups using the Kidney Disease Quality of Life Short Form. Compared with CHD patients, NHD patients had significantly greater improvements in “burden of kidney disease” between prerandomization and baseline as well as significantly greater improvement in “effects of kidney disease.”

“We detected clinically significant but not statistically significant changes in overall quality of life,” said Braden J. Manns, MD, MSc, one of the two principal investigators. “We would have needed a bigger study to determine if these changes are real.”

Dr. Manns is associate professor of medicine at the University of Calgary in Alberta. The other principal investigator is Bruce F. Culleton, MD, MSc, who became an employee of Baxter Healthcare after the study was completed.

Christopher T. Chan, MD, a leading NHD researcher, said the new findings are not dissimilar to results he and others have published. “It is important to note that the quality-of-life indices specific to kidney disease were improved after conversion to nocturnal hemodialysis,” remarked Dr. Chan, R. Fraser Elliott Chair in Home Dialysis and associate professor of medicine at the University of Toronto.

“Overall, the group [led by Drs. Manns and Culleton] did not find a statistically significant difference in quality of life, which is quite plausible and requires confirmation.”

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