Patients with kidney failure who receive dialysis at night at home can reduce their need for blood pressure medications and improve their quality of life, report Canadian researchers in JAMA, the Journal of the American Medical Association.
A research team led by Dr. Bruce F. Culleton, formerly of the University of Calgary, set out to determine the effects of nighttime hemodialysis compared with conventional clinic-based dialysis. They wanted to know how it affected blood pressure and left ventricular (LV) mass -- a measure of a thickened heart from elevated blood pressure.
About 60 per cent of kidney failure patients have a high LV mass, which puts them at a high risk of heart disease, says study co-author Dr. Braden Manns. Heart disease is responsible for the majority of deaths of kidney failure patients.
The three-year study involved 52 participants in Calgary and Edmonton. Half the group received dialysis at home while they slept, six times a week. The rest had conventional dialysis at a clinic three times weekly, for about four hours at a time.
LV mass decreased by an average of 13.8 grams in the nighttime dialysis group and increased by 1.5 grams in the conventional dialysis group, for a difference of 15.3 grams. Sixteen of those doing the nighttime dialysis were also able to reduce or discontinue their high blood pressure medication, versus only three in the conventional dialysis group.
"This type of dialysis reduces the negative effects of kidney dialysis on the heart and reduces, we believe, heart failure and sudden heart attacks," Culleton told Â鶹´«Ã½.
Part of the reason for the improved effects is the fact that clinic-based dialysis allows the machines to clean the blood for only about 12 hours a week, whereas nighttime dialysis is done for at least 35 hours a week.
Those doing the nighttime dialysis also reported that their health-related quality of life was so improved, it was similar in magnitude to having a kidney transplant.
"The benefit for patients is that they feel way better, some come off transplant lists," says Dr. David Mendelssohn, who heads up the dialysis program at Humber River Regional Hospital in Toronto.
Studies suggest home night dialysis may save about $10,000 per year, per patient, because they require less medication, develop fewer complications and end up in hospital far less often.
Yet the cost of the machines is high, as are the costs of training users and instructing those who the training. Currently, only about 200 people in Canada are able to take advantage of nighttime dialysis.
Most Canadian provinces still consider nighttime dialysis "experimental" and aren't funding the programs. Dr. Mendelssohn hopes the new data will help them reconsider.
"I believe many patients are suitable for this therapy and will benefit. I hope soon we can enter way more patients on this therapy," he says.
With a report from CTV medical specialist Avis Favaro and producer Elizabeth St. Philip
