Elsevier

Mayo Clinic Proceedings

Volume 73, Issue 11, November 1998, Pages 1035-1045
Mayo Clinic Proceedings

Improved Biochemical Variables, Nutrient Intake, and Hormonal Factors in Slow Nocturnal Hemodialysis: A Pilot Study

https://doi.org/10.4065/73.11.1035Get rights and content

Objective

To determine whether slow nocturnal hemodialysis (SNHD) can be safely performed in patients with end-stage renal disease to improve the biochemical and clinical outcome.

Material and Methods

We conducted an 8-week pilot study in nondiabetic adult patients, who underwent dialysis 6 nights per week for 8 hours each night. A dialysate flow rate of 300 mL/min and a blood flow rate of 250 mL/min, through an internal jugular dual-lumen venous catheter, were used. The equipment used was a COBE Centry System 3 dialysis machine and Fresenius F-80 (1.8 m2) or Baxter CT 190 (1.9 m2) dialyzers. Five patients were enrolled in the study.

Results

Two patients did not complete the study because of catheter-related lnfections—one at day 7 and one after 4 weeks of SNHD. All patients had improved blood pressure control, and no intradialytic adverse events occurred. Dietary intake improved, urea and creatinine levels significantly decreased, and weekly delivery of dialysate increased on SNHD. Potassium, chloride, β2-microglobulin, hosphorus, calcium, and high-density lipoprotein cholesterol all improved on SNHD. Serum testosterone increased in the three men on SNHD, but parathyroid hormone, luteinizing hormone, and follicle-stimulating hormone remained unchanged. Erythropoietin levels increased on SNHD, despite no change in exogenous erythropoietin doses in three patients and discontinuation of administration of erythropoietin in one. The following biochemical factors did not change significantly: serum sodium, bicarbonate, vitamin B 12, folate, alkaline phosphatase, total cholesterol, triglycerides, and albumin.

Conclusion

Higher doses of hemodialysis benefit nutrition, improve biochemical variables, and may improve many hormonal systems.

Section snippets

Study Subjects

Five adult patients with end-stage renal disease maintained on conventional (three times per week) hemodialysis were recruited into the study. All patients had documented end-stage renal disease (creatinine clearances less than or equal to 1.5 mL/min per 1.73 m2). Patients were excluded from the study if they had diabetes mellitus, documented cancer, dementia, angina during a 2-week period before the study, or active infections.

Protocol

On entrance into the study, the patients underwent a physical

RESULTS

Five patients (three men and two women) were enrolled in the study (Table 1). Three patients completed 8 weeks of SNHD before returning to conventional hemodialysis. One female patient (patient E) was removed from the study on day 7 because of an internal jugular catheter-related bacteremia believed to be due to unauthorized self-manipulation of the catheter—a self-induced complication related to her preexisting psychiatric illness. One man (patient B) had catheter-related sepsis and internal

DISCUSSION

The United States Renal Data System 1996 Annual Data Report revealed survival rates at 1, 2, and 5 years on conventional hemodialysis modalities to be 77.7%, 61.4%, and 29.4%, respectively.6 Just as alarming are the data reported by Held and associates,7, 8, 9, 10 which showed the US end-stage renal disease 5-year mortality rate to be 15% higher than for the countries of the European Dialysis and Transplant Association and 30% higher than in Japan. Critical review of the data showed that the

CONCLUSION

SNHD with use of high-flux dialyzers, large surface areas, a dialysate flow rate of 300 mL/min, and a blood flow rate of 250 mL/min can be safely performed without fear of accidental disconnections or intradialytic patient instability. This modality achieves higher solute clearances than conventional hemodialysis and thus results in improvement of many biochemical variables. Further long-term studies are necessary to explore changes in individual biochemical and endocrine factors seen in this

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