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One year experience of nocturnal home haemodialysis with an alternate night schedule in Hong Kong

Authors


Dr Hon-Lok Tang, Division of Nephrology, Department of Medicine and Geriatrics, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong, China. Email: tanghl@ha.org.hk

ABSTRACT

Aim:  Nocturnal home haemodialysis (NHHD) was started in Hong Kong in 2006. The experience of 1 year of NHHD with an alternate night schedule in two local centres is reported.

Methods:  The clinical parameters of 14 patients who had completed 1 year of NHHD were retrospectively analyzed. All patients were receiving an alternate night schedule (3.5 sessions/week) for 6–8 h/session.

Results:  After 1 year of NHHD, haemoglobin levels increased from 9.6 ± 1.6 g/dL before NHHD to 11.4 ± 2.2 g/dL (P < 0.05) despite a reduction in erythropoietin dose requirement from 120.6 ± 44.3 to 59.4 ± 74.6 U/kg/week (P < 0.05). Four patients (29%) were able to stop taking erythropoietin after NHHD. Serum phosphate levels reduced from 2.33 ± 0.41 to 1.59 ± 0.29 mmol/L (P < 0.01) and calcium phosphate product decreased from 5.29 ± 0.96 to 3.74 ± 0.90 mmol2/L2 (P < 0.01). Phosphate binder dose was greatly reduced and eight patients (67%) were able to stop taking phosphate binders. The number of antihypertensive medications tended to reduced from 2.5 ± 1.3 to 1.6 ± 1.5 (P = 0.067) with four patients (29%) able to stop antihypertensives. Left ventricular mass index decreased from 186 ± 62 to 168 ± 60 g/m2 (P = 0.463) although this was not statistically significant. Weekly spKt/V during conventional haemodialysis was 3.63 ± 0.95 while that during NHHD was three times higher at 11.09 ± 6.44 (P < 0.01). The quality of life indexes also showed improvement.

Conclusion:  This 1 year experience of alternate night NHHD demonstrates benefits in terms of anaemia control, erythropoietin requirement, serum phosphate and calcium phosphate product reduction, blood pressure control, haemodialysis adequacy and quality of life. NHHD with an alternate night schedule is a promising dialytic therapy for patients receiving chronic haemodialysis in this locality.

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