Nocturnal Hemodialysis Does not Improve Overall Measures of Quality of Life Compared to Conventional Hemodialysis
Braden J Manns; Michael W Walsh; Bruce F Culleton; Brenda Hemmelgarn; Marcello Tonelli; Melissa Schorr; Scott Klarenbach; for the Alberta Kidney Disease Network
Published: 03/20/2009
The discovery of hemodialysis greatly improves the management of patient with ESRD (CIHI, 2005). Regardless of the development in dialysis therapy, morbidity and mortally remains high among ESRD patients and there is seen discrepancy with the quality of life for these patients. Since 1940’s, the discovery of Noturnal hemodialysis provided improvements to overcoming some limitations of conventional hemdialysis (Walsh M, et al, 2005). The article wanted to further describe the impact of nocturnal hemodialysis on ESRD patients and its effect to the quality of life. A total of 69 patients agreed to participate in the study. Upon selection, only 51met the inclusion criteria in which they are randomized whether they are going to receive conventional or nocturnal hemodialysis. Patients assigned to nocturnal hemodialysis were monitored and given 5-6 hemodialysis per night for a minimum of 6 hours per night. Patients assigned to conventional hemodialysis received treatment thrice weekly. The study utilized an experimental research method having a experimental group (nocturnal hemodialysis) and a controlled group (conventional hemodialysis). The primary analysis used an intention-to-treat approach, Secondary analyses considered an 'observed cases' approach, and finally, a 'per protocol' analysis was considered only to patients who were actually receiving their assigned therapy at 6 months.
The study revealed that the quality of life did not exhibit a significant change among patients receiving nocturnal hemodialysis and conventional hemodialysis. Conversely, statistics provided clinical significance in the changes associated with kidney disease. The magnitude of difference in EQ-5D (subjective quality of life measurement questionnaire) supported the use of nocturnal hemodialysis over conventional hemodialysis.
The result of the study would provide patients with ESRD more options when choosing from available dialysis modalities. Patient will be able to consider the difference in therapies which may affect there lifestyle in the context of their individual preference and circumstances. If another follow up study will be conducted and shows significant cost-efficiency of nocturnal hemodialysis, then it would be more reasonable to suggest the latter treatment for patients who are willing to give-up a more demanding therapy for a potential of improved quality of life.
references:
Canadian Organ Replacement Registry: Treatment of End-Stage Organ Failure in Canada 2002 and 2003. Canadian Institutes of Health Information: Ottawa 2005.
Walsh M, Culleton B, Tonelli M et al. A systematic review of the effect of nocturnal hemodialysis on blood pressure, left ventricular hypertrophy, anemia, mineral metabolism, and health-related quality of life. Kidney Int 2005; 67: 1500-1508.
Authors and Disclosures
Braden J Manns,1,2 Michael W Walsh,1,2 Bruce F Culleton,1 Brenda Hemmelgarn,1,2 Marcello Tonelli,3 Melissa Schorr,1 Scott Klarenbach,3 for the Alberta Kidney Disease Network
1Department of Medicine, University of Calgary, Calgary, Alberta, Canada
2Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
3Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Braden J Manns; Michael W Walsh; Bruce F Culleton; Brenda Hemmelgarn; Marcello Tonelli; Melissa Schorr; Scott Klarenbach; for the Alberta Kidney Disease Network
Published: 03/20/2009
The discovery of hemodialysis greatly improves the management of patient with ESRD (CIHI, 2005). Regardless of the development in dialysis therapy, morbidity and mortally remains high among ESRD patients and there is seen discrepancy with the quality of life for these patients. Since 1940’s, the discovery of Noturnal hemodialysis provided improvements to overcoming some limitations of conventional hemdialysis (Walsh M, et al, 2005). The article wanted to further describe the impact of nocturnal hemodialysis on ESRD patients and its effect to the quality of life. A total of 69 patients agreed to participate in the study. Upon selection, only 51met the inclusion criteria in which they are randomized whether they are going to receive conventional or nocturnal hemodialysis. Patients assigned to nocturnal hemodialysis were monitored and given 5-6 hemodialysis per night for a minimum of 6 hours per night. Patients assigned to conventional hemodialysis received treatment thrice weekly. The study utilized an experimental research method having a experimental group (nocturnal hemodialysis) and a controlled group (conventional hemodialysis). The primary analysis used an intention-to-treat approach, Secondary analyses considered an 'observed cases' approach, and finally, a 'per protocol' analysis was considered only to patients who were actually receiving their assigned therapy at 6 months.
The study revealed that the quality of life did not exhibit a significant change among patients receiving nocturnal hemodialysis and conventional hemodialysis. Conversely, statistics provided clinical significance in the changes associated with kidney disease. The magnitude of difference in EQ-5D (subjective quality of life measurement questionnaire) supported the use of nocturnal hemodialysis over conventional hemodialysis.
The result of the study would provide patients with ESRD more options when choosing from available dialysis modalities. Patient will be able to consider the difference in therapies which may affect there lifestyle in the context of their individual preference and circumstances. If another follow up study will be conducted and shows significant cost-efficiency of nocturnal hemodialysis, then it would be more reasonable to suggest the latter treatment for patients who are willing to give-up a more demanding therapy for a potential of improved quality of life.
references:
Canadian Organ Replacement Registry: Treatment of End-Stage Organ Failure in Canada 2002 and 2003. Canadian Institutes of Health Information: Ottawa 2005.
Walsh M, Culleton B, Tonelli M et al. A systematic review of the effect of nocturnal hemodialysis on blood pressure, left ventricular hypertrophy, anemia, mineral metabolism, and health-related quality of life. Kidney Int 2005; 67: 1500-1508.
Authors and Disclosures
Braden J Manns,1,2 Michael W Walsh,1,2 Bruce F Culleton,1 Brenda Hemmelgarn,1,2 Marcello Tonelli,3 Melissa Schorr,1 Scott Klarenbach,3 for the Alberta Kidney Disease Network
1Department of Medicine, University of Calgary, Calgary, Alberta, Canada
2Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
3Department of Medicine, University of Alberta, Edmonton, Alberta, Canada