The effects of frequent nocturnal home hemodialysis: the Frequent
Hemodialysis Network Nocturnal Trial. This trial was launched because it was noticed from small studies that more frequent nocturnal
dialysis may help improve outcomes in dialysis patients. A multicenter study
headed by Dr. Rocco et al where 87
patients randomized to three times per week
conventional hemodialysis or to nocturnal hemodialysis six times per week, all
with single-use high-flux dialyzers. The 45 patients in the frequent nocturnal
arm had a 1.82-fold higher mean weekly stdKt/V(urea). NO significant effect of nocturnal
hemodialysis for either of the two coprimary outcomes (death or left
ventricular mass (measured by MRI) was found. Secondary outcomes included
cognitive performance, self-reported depression, laboratory markers of
nutrition, mineral metabolism and anemia, blood pressure and rates of
hospitalization, and vascular access interventions. Patients in the nocturnal
arm had improved control of hyperphosphatemia and hypertension, but no
significant benefit among the other main secondary outcomes. There was a
trend for increased vascular access events in the nocturnal arm. Sample size was
small which could have been a reason of these negative result.
A sister of this
trial was conducted: this time it was morning dialysis ( not nocturnal) but daily vs conventional hd on 245 patients. Compared two groups
6times weekly vs 3times weekly. This was an in-center trial. Average delivered 5.2 days vs
2.9 days in the two arms respectively. The time was shorter in the daily so the
total hours were only 20% more in the daily arm overall. However patients in
the daily arm still did better compared with the conventional group. Both
primary outcomes and secondary outcomes were the same as for the nocturnal trial but
they were significantly better for the latter(during the day). The reason for
the discordance is being investigated.( of note the nightly dialysis received
much more time on dialysis than either daily frequent or conventional)
Final note :
"FHN
participants were younger and the racial composition for each study was
different from the racial composition of the aggregate US dialysis population.
Catheters for vascular access were more common in FHN Nocturnal Trial
participants."
Post by
Dr. Azzour Hazzan
Hofstra NSLIJ Nephrology
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