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my personal edition > dialysis > news
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DGDispatch
Eight-Hour Overnight Dialysis Improves Survival Versus Four-Hour Dialysis: Presented at ASN
By Maggie Schwarz
PHILADELPHIA -- November 8, 2008 -- More frequent and/or longer dialysis regimens are a promising answer to the unacceptably high risk of death among dialysis patients, researchers reported at Renal Week 2008, the American Society of Nephrology (ASN) annual meeting.
"Undergoing dialysis for 8 hours overnight, 3 times a week reduces mortality risk by nearly 80% versus conventional 4-hour dialysis," announced Ercan Ok, MD, Department of Internal Medicine, Ege University Medical School, Izmir, Turkey, speaking here on November 7.
Dr. Ok and colleagues conducted the first prospective, controlled comparison of 8-hour versus 4-hour hemodialysis.
The researchers switched 224 conventional (4-hour) dialysis patients to thrice-weekly, overnight, in-center dialysis. The subjects adjusted well to overnight hemodiaysis, noted Dr. Ok. "After an adaptation period of a month, all patients slept during the night without any complaint," he reported.
Patients remained on overnight hemodialysis for about a year. Their outcomes were then compared with those of a similar group of patients who continued on conventional dialysis: 4 hours, 3 days per week. Controls were matched for age, sex, and diabetes status.
Overnight dialysis led to improvements in a wide range of outcomes. "The hospitalization rate during follow-up was one-fourth of that observed in patients treated with 4-hour conventional hemodialysis," said Dr. Ok.
Most importantly, longer dialysis produced significantly better patient outcomes, with a 78% reduction in mortality rate.
Patients receiving overnight hemodialysis had better blood pressure control, leading to a two-thirds reduction in blood pressure medications. These patients were also at lower risk of declines in blood pressure during dialysis -- a common problem with conventional hemodialysis. Phosphate levels decreased toward normal, despite a 72% reduction in medications used to reduce phosphate absorption. The need for other medications decreased as well. All these parameters either did not change or deteriorated in patients on 4-hour conventional dialysis.
Most patients in the overnight hemodialysis group mentioned an increase in appetite. They gained weight and their albumin levels rose. Many were able to return to work, reporting improved job performance and better cognitive functioning.
Dr. Ok noted that an important limitation in this study is that patients were not randomly assigned to the two dialysis strategies. Study patients were aged 45 years on average, which is younger than the general population of dialysis patients. Few older patients were willing to switch to overnight hemodialysis. Also, the follow-up period was relatively short. Nevertheless, Dr. Ok felt that the results would not differ with longer observation.
Funding for this study was provided by the European Nephrology Dialysis Institution.
[Presentation title: Eight-Hour Nocturnal In-Center Hemodialysis Provides Survival Benefit Over Four-Hour Conventional Hemodialysis. Abstract F-FC317]
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