Nocturnal dialysis: Comparing six night/week with alternate night therapy

The biochemical, haemodynamic, clinical, and nutritional benefits of nocturnal haemodialysis (NHD) compared with (c/w) 4 hr, 3/week conventional haemodialysis (CHD) are well known and accrue by increasing dialysis time and frequency either for 8 hrs alternate night/week (NHD3.5) or for 8 hrs 6 nights/week NHD (NHD6). However, there is little data yet comparing NHD3.5 with NHD6. 13 NHD6(8.15 hrs/night) were c/w 14 NHD3.5(7.8 hrs/night), all with similar demographic profiles. NHD6 had unrestricted diet and fluid intake but NHD3.5 needed some restriction. Before (b) and after (a) HD phosphate (PO4) control was ideal though bPO4 levels for NHD6 were lower (1.64 mmol/l) c/w NHD3.5(1.83 mmol/l). All NHD6 needed PO4 supplementation c/w 2/14 NHD3.5 but 5/14 NHD3.5 needed PO4 binders c/w 0/13 NHD6. Both had normal blood pressures with 3/14 NHD3.5 needing anti-hypertensives c/w 2/13 NHD6. The bHb was 122.8 g/l (NHD6) c/w 127.7 g/l (NHD3.5) and the balbumin was 38.3 g/l (NHD6) c/w 37.7 g/l (NHD3.5). NHD6 had lower b blood urea (10.2 c/w 19.5 mmol/l) and less interdialytic urea and creatinine fluctuation. NHD6 ultrafiltration rates (UFR) and intradialytic weight gains (mean ± SEM) were significantly lower (248 ± 22.7 ml/hr and 2.03 ± 0.19 kg) c/w NHD3.5(453 ± 34.6 ml/hr and 2.85 ± 0.27 kg): UFR p < 0.10. We conclude that NHD6 offers the optimum biochemical, volume, and clinical outcome but NHD3.5 still has a clear and major advantage over CHD and a dual additional appeal to providers seeking home-based therapy cost advantages and consumable expenditure control. A flexible dialysis program should offer all the time and frequency options of NHD but, in particular, should support NHD at a frequency sympathetic to the clinical, rehabilitation, and lifestyle aspirations of individual patients.