Converting to In-Center Nocturnal Hemodialysis Improves Lab Markershemodialysis (CHD) to in-center nocturnal hemodialysis (INHD) is associated with significant improvements in key laboratory markers, a study found.
Eduardo Lacson, Jr., MD, MPH, of Fresenius Medical Care North America (FMCNA), Waltham, Mass., and colleagues identified 556 patients from 77 FMCNA outpatient dialysis units who survived on CHD (three times a week, less than six hours per dialysis session) for at least 90 days and converted to thrice-weekly INHD (six or more hours per session) for more than 90 days.
Patients served as their own controls. Researchers obtained laboratory values for albumin, hemoglobin (Hb), calcium, phosphorus, white blood cells (WBCs), and standard weekly Kt/V for the 90 days preceding conversion to INHD, the first 90 days on INHD, and the 91-180 days on INHD. Of the 556 patients, 86% contributed data from all three periods.
After the switch, patients experienced significant increases in albumin, Hb, and calcium levels, and significant decreases in phosphorus levels and WBC. Subjects also had a significant increase in dialysis dose.
Mean albumin levels rose from 3.89 g/dL in the pre-conversion period to 3.94 and 3.94 g/dL for the first 90 days on INHD and 91-180 days on INHD, respectively, the investigators reported here at the National Kidney Foundation's 2010 Spring Clinical Meetings. Mean Hb levels rose from 11.75 g/dL to 12.04 and 12.12 g/dL, respectively. Phosphorus levels decreased from 5.85 mg/dL to 5.00 and 5.12 mg/dL, respectively.
Calcium levels increased from 9.06 mg/dL to 9.24 and 9.25 mg/dL, respectively, and the WBC decreased from 7.33 to 7.08 and 7.08 (×103), respectively. The standard weekly Kt/V increased from 2.32 to 2.89 and 2.89, respectively. Transferrin saturation values did not change significantly.