Trial Questions the Benefits of Frequent Nocturnal Dialysis

Nocturnal home dialysis performed six nights weekly does not improve mortality or other outcomes compared with conventional hemodialysis three times weekly, concludes a trial in Kidney International.

In the Frequent Hemodialysis Network Nocturnal Trial, 87 patients were randomly assigned to undergo conventional hemodialysis performed three times weekly or nocturnal home dialysis performed six times weekly. Single-use high-flux dialyzers were used for all sessions.

The patients assigned to frequent nocturnal home dialysis had a mean dialysis weekly standard of 4.72 Kt/Vurea, compared with Kt/Vurea in the conventional dialysis group. The average number of weekly treatments was about 75 percent higher, and the average weekly treatment time was more than twice as high.

Nevertheless, there was no significant difference in either of two coprimary outcomes: death or left ventricular mass, measured by magnetic resonance imaging; or death or SF-36 RAND Physical Health Composite. Frequent nocturnal dialysis was associated with better control of hyperphosphatemia and hypertension, with a trend toward increased vascular access interventions. Cognitive function and hospitalization were similar between groups.

Previous small studies have suggested that more frequent hemodialysis sessions, performed in the patient’s home at night, might have clinical benefits. The new trial finds few significant differences in outcomes with frequent nocturnal home dialysis compared with conventional hemodialysis. The authors note some key limitations of their study, including small sample size and reduced adherence to prescribed dialysis in the group receiving frequent nocturnal dialysis. [Rocco MV, et al. The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial. Kidney Int 2011; 80:1080–1091.]

December 2011 (Vol 3, Number 12)