Switching to Nocturnal Hemodialysis Beneficial

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ORLANDO, Fla.—Patients converted from in-center conventional hemodialysis (ICHD) to in-center nocturnal hemodialysis (NHD) have improvements in serum phosphorus levels and blood pressure (BP) control, according to two studies of the same cohort of 418 patients.

ICHD consisted of 3-4 hour dialysis treatments three times a week and NHD consisted of 6-8 hour dialysis treatments three times a week. The investigators defined the baseline period as the last six months before starting NHD and the NHD period as months 4 through 9 post-conversion.

In one study, led by Robert I. Lynn, MD, of Nephrology & Hypertension Associates in Bronx, N.Y., the mean serum phosphate levels decreased 0.67 mg/dL during the first month of NHD. The levels decreased significantly from 5.8 mg/dL at baseline to 5.1 mg/dL in the nine months after conversion, investigators reported here at the National Kidney Foundation's 2010 Spring Clinical Meetings. In addition, calcium×phosphorus product decreased significantly and paracalcitol administration increased significantly from baseline after conversion. Parathyroid hormone (PTH) levels decreased after conversion, but not significantly.

The researchers noted that the lower phosphate level may have encouraged more aggressive use of paracalcitol to lower PTH. They also observed that the decrease in serum phosphate, calcium×phosphorus product, and PTH may result in long-term cardiovascular benefits for NHD patients.

In the other study, led by Robert Provenzano, MD, Chief of the Section of Nephrology at St. John Hospital and Medical Center in Detroit, both dialysis modes achieved equivalent BP control but the percent of patients using anti-hypertensive drugs decreased 4.4% after the switch to NHD. Systolic BP fell from 151 to 131 mm Hg, but this was not statistically significant.

“These results suggest both clinical and economic benefits may be realized from NHD,” the authors concluded.

Study findings were presented at the National Kidney Foundation 2010 Spring Clinical Meetings.

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