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.
Jansz, T. T., Özyilmaz, A., Grooteman, M. P. C., Hoekstra, T., Romijn, M., Blankestijn, P. J., ... van Jaarsveld, B. C. (2018). 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. BMJ Open, 8(3), [e019900]. https://doi.org/10.1136/bmjopen-2017-019900, https://doi.org/10.1136/bmjopen-2017-019900