For Some Kidney Patients, Home Dialysis Is Better
SATURDAY July 25, 2009 -- More than 340,000 Americans are on dialysis to treat kidney failure, but only a tiny fraction are taking advantage of a treatment option that may improve their quality of life.
Studies suggest that home hemodialysis administered overnight, otherwise known as "nocturnal dialysis," may be a better way to go for some patients. The key advantage is it allows for many more hours of blood-cleansing therapy than a kidney patient would typically receive in a conventional, three-times-a-week dialysis center-based program.
"If I had kidney failure, and I think this applies to at least a number of physicians who know what all this is about, what we would do is we would do overnight dialysis six nights a week," said Dr. Christopher R. Blagg, professor emeritus of medicine at the University of Washington and executive director emeritus of Northwest Kidney Centers in Seattle.
Hemodialysis is one of two main types of dialysis treatment administered when a person's kidneys are no longer functioning. It uses a machine to remove wastes and excess fluid from the blood. (Peritoneal dialysis, by contrast, uses the lining of the patient's own abdomen as a filtering device.)
When home hemodialysis is performed overnight, the patient sleeps while the machine does its work. Treatment usually takes place six days a week or every other night over a six- to eight-hour stretch, says the National Kidney Foundation.
Experts say it's not for everyone, particularly people with other serious medical problems, such as cardiovascular disease. But science is beginning to show that nocturnal dialysis has significant advantages.
In a study published in the Journal of the American Medical Association, researchers randomly assigned 52 patients to receive either frequent nocturnal hemodialysis, meaning five or six days a week for a minimum of six hours, or conventional hemodialysis treatments three times weekly. Patients in the nighttime portion of the study were trained to perform hemodialysis at home.
After six months, those receiving nighttime treatments had better heart health, blood pressure and some measures of quality of life than those in conventional treatment.
And Turkish researchers found that eight-hour nighttime treatments performed three times a week cut the death risk of patients by 80 percent compared with conventional four-hour treatments done three times a week. The findings were presented at last year's annual meeting of the American Society of Nephrology.
Dr. Michael V. Rocco, a professor of internal medicine-nephrology at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., says doctors may know more about the effects of more frequent dialysis in the next few years as a result of two National Institutes of Health-sponsored clinical trials.
In one study, patients will receive treatment at a dialysis center on a conventional, three-times-a-week basis or on a frequent, six-times-a-week schedule. The other study will compare nocturnal hemodialysis administered six times a week for at least six hours with conventional, three-times-a-week home hemodialysis.
"These studies on daily and nocturnal [hemodialysis] will provide us with far more dependable information than we now have with observational studies alone," Rocco said.
At present, fewer than 1 percent of all U.S. dialysis patients -- roughly 3,000 people -- do home hemodialysis, Blagg noted.
Several factors are contributing to the lack of growth in nocturnal hemodialysis in the United States, Rocco noted. These include a lack of training in home hemodialysis, especially nocturnal dialysis, making physicians reluctant to recommend it to patients. Funding for home hemodialysis training is inadequate, and physicians and staff aren't promoting it, he added.
But Congress passed legislation last year that could influence the popularity of that option. Effective Jan. 1, 2010, patients with chronic kidney disease must be counseled about their treatment options. This provision is intended to give patients an opportunity to participate in choosing the therapy that they receive.
"I don't know how much difference that will make, but it's a step in the right direction," Blagg said.
The National Kidney Foundation has more on home hemodialysis.
Posted: July 2009