Thrice-weekly in-center nocturnal hemodialysis: An effective strategy to optimize chronic dialysis therapy

Objectives: Daily nocturnal hemodialysis (NHD) has been proposed as a valuable strategy to improve outcomes for patients on conventional hemodialysis (CHD), but it is burdened by high costs and logistic issues. Thrice NHD might represent a more affordable approach to improve hemodialysis patient outcome. Methods: Here we retrospectively analyzed the data on blood pressure, body weight, and hematochemical parameters in a cohort of 7 patients (mean age 50.4 +/- 11.0 years, duration of CHD 14.3 +/- 11.5 years) who registered in the NHD program at the dialysis unit of Ospedali Riuniti, Bergamo, Italy. Data for the 2 first years of NHD were compared with those of the last year on CHD. Results: At 2 years after start of NHD, we found a significant decrease in systolic (149.4 +/- 16.6 vs. 128.4 +/- 26.0 mm Hg, p<0.001) and diastolic (87.7 +/- 11.1 vs. 79.6 +/- 16.7 mm Hg, p<0.05) blood pressure, along with a significant reduction in the use of per-patient antihypertensive agents (1.17 +/- 1.19 vs. 0.47 +/- 0.89, p<0.05) and an increase in dry body weight (61.4 +/- 21.8 vs. 67.1 +/- 16.4 kg, p<0.001). Moreover, patients had a significant reduction in phosphate levels (6.2 +/- 2.4 vs. 5.4 +/- 3.0 mg/dL, p<0.01). The procedure was safe and well tolerated and did not require extra cost for ad hoc facilities. Conclusion: NHD is an effective approach to optimize chronic dialysis therapy. (Int J Artif Organs 2009; 32: 12-9)