Long-Term clinical parameters after switching to nocturnal haemodialysis: A Dutch propensity-score-matched cohort study comparing patients on nocturnal haemodialysis with patients on three-Times-A-week haemodialysis/haemodiafiltration

Thijs Thomas Jansz, Akin Özyilmaz, Muriel P. C. Grooteman, Tiny Hoekstra, Marieke Romijn, Peter J. Blankestijn, Michael L. Bots, Brigit C. van Jaarsveld

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives Nocturnal haemodialysis (NHD), characterised by 8-hour sessions ≥3 times a week, is known to improve clinical parameters in the short term compared with conventional-schedule haemodialysis (HD), generally 3×3.5-4 hours a week. We studied long-Term effects of NHD and used patients on conventional HD/haemodiafiltration (HDF) as controls. Design Four-year prospective follow-up of patients who switched to NHD; we compared patients with patients on HD/HDF using propensity score matching. Setting 28 Dutch dialysis centres. Participants We included 159 patients starting with NHD any time since 2004, aged 56.7±12.9 years, with median dialysis vintage 2.3 (0.9-5.1) years. We propensity-score matched 100 patients on NHD to 100 on HD/HDF. Primary and secondary outcome measures Control of hypertension (predialysis blood pressure, number of antihypertensives), phosphate (phosphate, number of phosphate binders), nutritional status and inflammation (albumin, C reactive protein and postdialysis weight) and anaemia (erythropoiesis-stimulating agent (ESA) resistance). Results Switching to NHD was associated with a non-significant reduction of antihypertensives compared with HD/HDF (OR <2 types 2.17, 95% CI 0.86 to 5.50, P=0.11); and a prolonged lower need for phosphate binders (OR <2 types 1.83, 95% CI 1.10 to 3.03, P=0.02). NHD was not associated with significant changes in blood pressure or phosphate. NHD was associated with significantly higher albumin over time compared with HD/HDF (0.70 g/L/year, 95% CI 0.10 to 1.30, P=0.02). ESA resistance decreased significantly in NHD compared with HD/HDF, resulting in a 33% lower ESA dose in the long term. Conclusions After switching to NHD, the lower need for antihypertensives, phosphate binders and ESA persists for at least 4 years. These sustained improvements in NHD contrast significantly with the course of these parameters during continued treatment with conventional-schedule HD and HDF. NHD provides an optimal form of dialysis, also suitable for patients expected to have a long waiting time for transplantation or those convicted to indefinite dialysis.
Original languageEnglish
Article numbere019900
JournalBMJ Open
Volume8
Issue number3
DOIs
Publication statusPublished - 2018

Cite this

@article{3abf38db213b429f95e3f2a769229957,
title = "Long-Term clinical parameters after switching to nocturnal haemodialysis: A Dutch propensity-score-matched cohort study comparing patients on nocturnal haemodialysis with patients on three-Times-A-week haemodialysis/haemodiafiltration",
abstract = "Objectives Nocturnal haemodialysis (NHD), characterised by 8-hour sessions ≥3 times a week, is known to improve clinical parameters in the short term compared with conventional-schedule haemodialysis (HD), generally 3×3.5-4 hours a week. We studied long-Term effects of NHD and used patients on conventional HD/haemodiafiltration (HDF) as controls. Design Four-year prospective follow-up of patients who switched to NHD; we compared patients with patients on HD/HDF using propensity score matching. Setting 28 Dutch dialysis centres. Participants We included 159 patients starting with NHD any time since 2004, aged 56.7±12.9 years, with median dialysis vintage 2.3 (0.9-5.1) years. We propensity-score matched 100 patients on NHD to 100 on HD/HDF. Primary and secondary outcome measures Control of hypertension (predialysis blood pressure, number of antihypertensives), phosphate (phosphate, number of phosphate binders), nutritional status and inflammation (albumin, C reactive protein and postdialysis weight) and anaemia (erythropoiesis-stimulating agent (ESA) resistance). Results Switching to NHD was associated with a non-significant reduction of antihypertensives compared with HD/HDF (OR <2 types 2.17, 95{\%} CI 0.86 to 5.50, P=0.11); and a prolonged lower need for phosphate binders (OR <2 types 1.83, 95{\%} CI 1.10 to 3.03, P=0.02). NHD was not associated with significant changes in blood pressure or phosphate. NHD was associated with significantly higher albumin over time compared with HD/HDF (0.70 g/L/year, 95{\%} CI 0.10 to 1.30, P=0.02). ESA resistance decreased significantly in NHD compared with HD/HDF, resulting in a 33{\%} lower ESA dose in the long term. Conclusions After switching to NHD, the lower need for antihypertensives, phosphate binders and ESA persists for at least 4 years. These sustained improvements in NHD contrast significantly with the course of these parameters during continued treatment with conventional-schedule HD and HDF. NHD provides an optimal form of dialysis, also suitable for patients expected to have a long waiting time for transplantation or those convicted to indefinite dialysis.",
keywords = "albumin, erythropoietin, haemodialysis, nocturnal haemodialysis, phosphate binders, propensity score matching",
author = "Jansz, {Thijs Thomas} and Akin {\"O}zyilmaz and Grooteman, {Muriel P. C.} and Tiny Hoekstra and Marieke Romijn and Blankestijn, {Peter J.} and Bots, {Michael L.} and {van Jaarsveld}, {Brigit C.}",
year = "2018",
doi = "10.1136/bmjopen-2017-019900",
language = "English",
volume = "8",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "3",

}

Long-Term clinical parameters after switching to nocturnal haemodialysis : A Dutch propensity-score-matched cohort study comparing patients on nocturnal haemodialysis with patients on three-Times-A-week haemodialysis/haemodiafiltration. / Jansz, Thijs Thomas; Özyilmaz, Akin; Grooteman, Muriel P. C.; Hoekstra, Tiny; Romijn, Marieke; Blankestijn, Peter J.; Bots, Michael L.; van Jaarsveld, Brigit C.

In: BMJ Open, Vol. 8, No. 3, e019900, 2018.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Long-Term clinical parameters after switching to nocturnal haemodialysis

T2 - A Dutch propensity-score-matched cohort study comparing patients on nocturnal haemodialysis with patients on three-Times-A-week haemodialysis/haemodiafiltration

AU - Jansz, Thijs Thomas

AU - Özyilmaz, Akin

AU - Grooteman, Muriel P. C.

AU - Hoekstra, Tiny

AU - Romijn, Marieke

AU - Blankestijn, Peter J.

AU - Bots, Michael L.

AU - van Jaarsveld, Brigit C.

PY - 2018

Y1 - 2018

N2 - Objectives Nocturnal haemodialysis (NHD), characterised by 8-hour sessions ≥3 times a week, is known to improve clinical parameters in the short term compared with conventional-schedule haemodialysis (HD), generally 3×3.5-4 hours a week. We studied long-Term effects of NHD and used patients on conventional HD/haemodiafiltration (HDF) as controls. Design Four-year prospective follow-up of patients who switched to NHD; we compared patients with patients on HD/HDF using propensity score matching. Setting 28 Dutch dialysis centres. Participants We included 159 patients starting with NHD any time since 2004, aged 56.7±12.9 years, with median dialysis vintage 2.3 (0.9-5.1) years. We propensity-score matched 100 patients on NHD to 100 on HD/HDF. Primary and secondary outcome measures Control of hypertension (predialysis blood pressure, number of antihypertensives), phosphate (phosphate, number of phosphate binders), nutritional status and inflammation (albumin, C reactive protein and postdialysis weight) and anaemia (erythropoiesis-stimulating agent (ESA) resistance). Results Switching to NHD was associated with a non-significant reduction of antihypertensives compared with HD/HDF (OR <2 types 2.17, 95% CI 0.86 to 5.50, P=0.11); and a prolonged lower need for phosphate binders (OR <2 types 1.83, 95% CI 1.10 to 3.03, P=0.02). NHD was not associated with significant changes in blood pressure or phosphate. NHD was associated with significantly higher albumin over time compared with HD/HDF (0.70 g/L/year, 95% CI 0.10 to 1.30, P=0.02). ESA resistance decreased significantly in NHD compared with HD/HDF, resulting in a 33% lower ESA dose in the long term. Conclusions After switching to NHD, the lower need for antihypertensives, phosphate binders and ESA persists for at least 4 years. These sustained improvements in NHD contrast significantly with the course of these parameters during continued treatment with conventional-schedule HD and HDF. NHD provides an optimal form of dialysis, also suitable for patients expected to have a long waiting time for transplantation or those convicted to indefinite dialysis.

AB - Objectives Nocturnal haemodialysis (NHD), characterised by 8-hour sessions ≥3 times a week, is known to improve clinical parameters in the short term compared with conventional-schedule haemodialysis (HD), generally 3×3.5-4 hours a week. We studied long-Term effects of NHD and used patients on conventional HD/haemodiafiltration (HDF) as controls. Design Four-year prospective follow-up of patients who switched to NHD; we compared patients with patients on HD/HDF using propensity score matching. Setting 28 Dutch dialysis centres. Participants We included 159 patients starting with NHD any time since 2004, aged 56.7±12.9 years, with median dialysis vintage 2.3 (0.9-5.1) years. We propensity-score matched 100 patients on NHD to 100 on HD/HDF. Primary and secondary outcome measures Control of hypertension (predialysis blood pressure, number of antihypertensives), phosphate (phosphate, number of phosphate binders), nutritional status and inflammation (albumin, C reactive protein and postdialysis weight) and anaemia (erythropoiesis-stimulating agent (ESA) resistance). Results Switching to NHD was associated with a non-significant reduction of antihypertensives compared with HD/HDF (OR <2 types 2.17, 95% CI 0.86 to 5.50, P=0.11); and a prolonged lower need for phosphate binders (OR <2 types 1.83, 95% CI 1.10 to 3.03, P=0.02). NHD was not associated with significant changes in blood pressure or phosphate. NHD was associated with significantly higher albumin over time compared with HD/HDF (0.70 g/L/year, 95% CI 0.10 to 1.30, P=0.02). ESA resistance decreased significantly in NHD compared with HD/HDF, resulting in a 33% lower ESA dose in the long term. Conclusions After switching to NHD, the lower need for antihypertensives, phosphate binders and ESA persists for at least 4 years. These sustained improvements in NHD contrast significantly with the course of these parameters during continued treatment with conventional-schedule HD and HDF. NHD provides an optimal form of dialysis, also suitable for patients expected to have a long waiting time for transplantation or those convicted to indefinite dialysis.

KW - albumin

KW - erythropoietin

KW - haemodialysis

KW - nocturnal haemodialysis

KW - phosphate binders

KW - propensity score matching

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UR - https://www.ncbi.nlm.nih.gov/pubmed/29523566

U2 - 10.1136/bmjopen-2017-019900

DO - 10.1136/bmjopen-2017-019900

M3 - Article

VL - 8

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 3

M1 - e019900

ER -