Abstract

NAVARRO, David et al. Long nocturnal dialysis: A single-centre experience. Port J Nephrol Hypert [online]. 2014, vol.28, n.4, pp.292-299. ISSN 0872-0169.

The institution of intensified dialysis regimens (as long treatment time, with reduced ultrafiltration per hour) has been associated with decreased morbidity and mortality in patients with end-stage chronic kidney disease. The performance of the haemodialysis session during the night interval emerged as logical, since it is an “idle” period, and has been associated with better small molecule dialysis, better blood pressure control, reduced medication requirements and improved quality of life. Recently, our centre initiated a long nocturnal dialysis programme and a prospective observational analysis was designed to evaluate the results of this approach. Mean values of clinical and laboratory variables were compared in 2 consecutive semesters: prior and after transition from haemodiafiltration to long nocturnal dialysis. After 6 months of switching, there was an increase in dialysis efficiency (reduction in pre-dialysis urea (129.74 ± 28.7 vs. 114.53 ± 23.94 mg/dl, p = 0.01) and an increase in Kt/V (1.75 ± 0.37 vs. 2.09 ± 0.39, p = 0.005)), improved hyperphosphatemia control (5.05 ± 0.9 vs. 4.23 ± 0.93 mg/dl; p = 0.01) and anaemia control, with a significant reduction in the use of darbepoetin alfa (38.5 ± 24.18 vs. 30.83 ± 22.54 μg/week; p = 0.04) and of intravenous iron (189.33 ± 117 vs. 116 ± 67 mg/month; p = 0.04) and a much better correction of overhydration (evaluated by the “BCM-Body composition monitor”: 10.2% ± 8.63 vs. 4.6% ± 7.2; p = 0.01), reflecting the patients’ overall better nutritional status. These excellent results were amplified by the patients’ perception of improvement in their quality of life. Our findings are consistent with the studies that favour long nocturnal dialysis over conventional regimens, but randomized controlled trials are needed to validate these findings.

Keywords : Anaemia; blood pressure; mineral and bone disease; nocturnal dialysis; outcome; quality of life.

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