Nocturnal in-center dialysis shows benefits over conventional treatment
WASHINGTON — Patients who chose in-center nocturnal hemodialysis at a large dialysis organization had improved solute clearance, lower ultrafiltration rates, improved nutritional parameters and lower hospitalization rates compared to patients who had conventional, in-center hemodialysis, according to results presented at ASN Kidney Week here.
The overnight therapy might be particularly beneficial to patients receiving standard in-center hemodialysis (ICHD) “who are not achieving risk factor control, are experiencing increased organ stunning risk with elevated [ultrafiltration] UF rates or with hemodynamic instability,” wrote lead study author Martin Schreiber, MD, and colleagues from DaVita Kidney Care.
For the study, all patients who were in the in-center nocturnal hemodialysis (INHD) programs of the large dialysis organization during 2017 and 2018 were included. Researchers looked at several factors in the comparison, including patient demographics, dialysis prescription data, laboratory markers, blood pressure, target weight and hospitalization rates.
Data were assessed and compared to those for patients on ICHD treated at the large dialysis organization during the same period. In total, 2,747 patients treated in 176 INHD programs were included in the study,
The study did run into some obstacles, the authors noted: 19 INHD programs started operation during 2018; another 24 had to close.
“The most common closure reasons were transition of patients to the working shift (82%) and staffing constraints (9%),” the authors wrote. “At the clinics in the study, mean INHD program census was less than 10 patients, mean operating time was 8.9 hours/shift, and staff retention rate was 83%.”
Mean age of patients in the INHD group was 52 years; 29.5% were women. To identify vascular access types, 68.9% of the patient group had an arteriovenous fistula and 15.1% had an arteriovenous graft.
“In the comparison of the two modality options, we found one of the key advantages of ICNHD was the ability to remove fluid at a lower (ultrafiltration) rate due to the extended treatment time,” Schreiber told Healio Nephrology in an email. Hospitalization rate (admissions per patient per year) was 1.40 in the INHD group compared to 1.82 in the control group.
Schreiber said a number of patients who were in the ICNHD program chose that option because they had a job or wanted to free up their days. “Nocturnal fit their lifestyle and work requirements and they did not want to undertake nocturnal at home,” Schreiber wrote. “Patients selected the option to ‘stay healthy’ in preparation for transplant.
“Likewise, if a patient was considering nocturnal at home, they could do a trial on the modality first in center and participated in ‘self-care.’”
In the ICNHD group, serum levels of more than 3.5 g/dL were present in 85.4% of patients compared to 71.4% in the conventional dialysis group.
“Patients receiving standard ICHD who are not achieving risk factor control, are experiencing increased organ stunning risk with elevated UF rates or with hemodynamic instability should be considered for transition to ICNHD,” Schreiber and colleagues wrote in the poster.– by Mark E. Neumann
Schreiber M, et al. FRP0478. Presented at: ASN Kidney Week; Nov. 7-10, 2019; Washington, D.C.
Disclosures: The study was funded by DaVita Kidney Care. The authors are employees of DaVita.