The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial

Michael V Rocco; Gerald J Beck; Paul W Eggers; Jennifer J Gassman; Tom Greene; Brett Larive; Christopher T Chan; Glenn M Chertow; Michael Copland; Christopher D Hoy; Robert M Lindsay; Nathan W Levin; Daniel B Ornt; Andreas Pierratos; Mary F Pipkin; Sanjay Rajagopalan; John B Stokes; Mark L Unruh; Robert A Star; Alan S Kliger; Frequent Hemodialysis Network (FHN) Trial Group

doi:10.1038/ki.2011.213

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The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial

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The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial

Michael V Rocco, Gerald J Beck, Paul W Eggers, Jennifer J Gassman, Tom Greene, Brett Larive, Christopher T Chan, Glenn M Chertow, Michael Copland, Christopher D Hoy, …

Kidney international, Vol.80(10), pp.1080-1091

11/02/2011

DOI: 10.1038/ki.2011.213

PMCID: PMC3569086

PMID: 21775973

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Abstract

Prior small studies have shown multiple benefits of frequent nocturnal hemodialysis compared to conventional three times per week treatments. To study this further, we randomized 87 patients to three times per week conventional hemodialysis or to nocturnal hemodialysis six times per week, all with single-use high-flux dialyzers. The 45 patients in the frequent nocturnal arm had a 1.82-fold higher mean weekly stdKt/Vurea, a 1.74-fold higher average number of treatments per week, and a 2.45-fold higher average weekly treatment time than the 42 patients in the conventional arm. We did not find a significant effect of nocturnal hemodialysis for either of the two coprimary outcomes (death or left ventricular mass (measured by MRI) with a hazard ratio of 0.68, or of death or RAND Physical Health Composite with a hazard ratio of 0.91). Possible explanations for the left ventricular mass result include limited sample size and patient characteristics. Secondary outcomes included cognitive performance, self-reported depression, laboratory markers of nutrition, mineral metabolism and anemia, blood pressure and rates of hospitalization, and vascular access interventions. Patients in the nocturnal arm had improved control of hyperphosphatemia and hypertension, but no significant benefit among the other main secondary outcomes. There was a trend for increased vascular access events in the nocturnal arm. Thus, we were unable to demonstrate a definitive benefit of more frequent nocturnal hemodialysis for either coprimary outcome.

Hemodialysis

randomized clinical trial

nocturnal hemodialysis

left ventricular mass

RAND physical health composite (PHC) SF-36

vascular access

Details

Title: Subtitle: The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial
Creators: Michael V Rocco - Medical Center Boulevard, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
Gerald J Beck - Cleveland Clinic Foundation, Cleveland, Ohio, USA
Paul W Eggers - National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
Jennifer J Gassman - Cleveland Clinic Foundation, Cleveland, Ohio, USA
Tom Greene - University of Utah, Salt Lake City, Utah, USA
Brett Larive - Cleveland Clinic Foundation, Cleveland, Ohio, USA
Christopher T Chan - University Health Network, University of Toronto, Ontario, Canada
Glenn M Chertow - Stanford University, Palo Alto, California, USA
Michael Copland - University of British Columbia at Vancouver, Vancouver, British Columbia, Canada
Christopher D Hoy - Rubin Dialysis Center, Saratoga Springs, New York, USA
Robert M Lindsay - University of Western Ontario, London, Ontario, Canada
Nathan W Levin - Renal Research Institute, New York City, New York, USA
Daniel B Ornt - Case Western Reserve University, Cleveland, Ohio, USA
Andreas Pierratos - Humber River Regional Hospital, University of Toronto, Weston, Ontario, Canada
Mary F Pipkin - Lynchburg Nephrology Physicians, University of Virginia, Lynchburg, Virginia, USA
Sanjay Rajagopalan - Ohio State University, Columbus, Ohio, USA
John B Stokes - University of Iowa and Iowa City VA Medical Center, Iowa City, Iowa, USA
Mark L Unruh - University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Robert A Star - National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
Alan S Kliger - Hospital of St Raphael, Yale University, New Haven, Connecticut, USA
Frequent Hemodialysis Network (FHN) Trial Group
Contributors: L Hunsicker (Contributor) - University of Iowa, Internal Medicine
D Somers (Contributor) - University of Iowa, Internal Medicine
Resource Type: Journal article
Publication Details: Kidney international, Vol.80(10), pp.1080-1091
DOI: 10.1038/ki.2011.213
PMID: 21775973
PMCID: PMC3569086
NLM abbreviation: Kidney Int
ISSN: 0085-2538
eISSN: 1523-1755
Publisher: Elsevier Inc
Language: English
Date published: 11/02/2011
Academic Unit: Nephrology; Internal Medicine
Record Identifier: 9984094526602771

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