Enhanced solute removal with intermittent, in-center, 8-hour nocturnal hemodialysis
Article first published online: 12 OCT 2009
© 2009 The Authors. Journal compilation © 2009 International Society for Hemodialysis
Volume 13, Issue 4, pages 487–491, October 2009
How to Cite
TROIDLE, L., FINKELSTEIN, F., HOTCHKISS, M. and LEYPOLDT, J. K. (2009), Enhanced solute removal with intermittent, in-center, 8-hour nocturnal hemodialysis. Hemodialysis International, 13: 487–491. doi: 10.1111/j.1542-4758.2009.00383.x
- Issue published online: 12 OCT 2009
- Article first published online: 12 OCT 2009
- Manuscript received October 2008; revised March 2009.
- Nocturnal hemodialysis;
- β-2 microglobulin;
Advances in the dialysis technique and increasing urea Kt/V have not improved outcomes for end-stage renal disease patients maintained on hemodialysis (HD) therapy. Attention has, thus, focused on enhancing solute removal via prolonged HD sessions. A reduction in the serum levels of phosphorus and β-2-microglobulin (B2M) with longer HD treatments has been linked to improved patient outcomes. We have shown that serum phosphorus levels are significantly lowered in patients maintained on thrice-weekly, in-center, 8-hour nocturnal HD performed at a blood flow rate of 400 mL/min. The kinetics of this modality were examined. A total of 8 patients participated in the study (age 45±7 years). Serum creatinine levels decreased from 9.2±1.9 to 3.0±1.0 mg/dL at 8 hours while serum phosphorus decreased from 5.7±1.9 to 2.5±0.7 mg/dL at 8 hours. The initial decrease from predialysis values to 1 hour after the start of HD was significant for both creatinine (P<0.0001) and phosphorus (P<0.001). Serum B2M decreased from 26.8±5.5 mg/L predialysis to 14.9±7.0 mg/L at 8 hours (P<0.01). Dialysate-side clearances of phosphorus and creatinine were 136±13 and 143±27 cm3/min, respectively. Phosphorus clearances were steadily maintained during the 8-hour session. A total of 904±292 mg of phosphorus was removed during the 8-hour treatment, with 501±174 mg (55%) removed during the first 4 hours and the remaining 45% continuously removed during the latter one-half of the session. The overall calculated B2M clearance was 55.1±40.3 cm3/min using the immediate post-B2M value and 28.4±34.2 mg/L using the 30-minute postdialysis value for the calculation. Serum levels of phosphorus and B2M decrease dramatically during an 8-hour session. Future studies are necessary to determine whether the enhanced solute removal with longer HD sessions translates into an improved outcome for HD patients.