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Overnight Dialysis - Sleeping Through Dialysis

Dialysis is usually a long slow process, taking hours at a time of a kidney disease patient's time severel days each week. It can get boring. So why not do it overnight while asleep?

This is the opinion of a research project from 2009, which said that it was much more convenient for some patients and had some significant benefits when compared to shorter daytime treatments. Indeed research has shown that more frequent but shorter dialysis treatments leads to more problems with damage to the access point used.

Normal dialysis can involve spending three to five hours connected to the machine three days a week. Yet for some people even this arduous schedule isn't enough. so some clinics offer an alternative regime: three times a week the patient receives overnight dialysis sessions lasting for 6 hours or more.

A group of researchers based in the UK carried out this study. Dr. Joanna Ruth Powell (Western Infirmary, United Kingdom) and her colleagues compared the health of patients who received long overnight dialysis sessions with those who received conventional dialysis during the day. During 10 years of study, 146 patients in their clinic chose long overnight dialysis (approximately 11% of their dialysis patients). Patients ranged vastly in age with 30 over the age of 70 years. The overnight therapy was well tolerated with only a third of patients converting back to conventional dialysis after an average of approximately two years, mostly for preferential rather than medical reasons.

The research team examined a variety of health parameters to detect any pros or cons for this treatment regime. They found that those who chose the overnight treatment option had lower rates of anemia, and reduced levels of urea in their blood.

Data source: American Society of Nephrology (2009, May 25). Sleeping Through Dialysis: No Nightmare For Kidney Patients. ScienceDaily. Retrieved from http://www.sciencedaily.com­ /releases/2009/05/090521171438.htm.

Normal dialysis has sometimes been described as a rather harsh treatment, due to the long hours involved. As the speed and aggressiveness of the treatment increases, the general health and well being of the patient decreases. Overnight dialysis was investigated in the 1960s, but the modern age of more frequent overnight dialysis started in 1993 with work in Toronto, Canada. While in France overnight treatment was also offered. Nocturnal Haemodialysis is now available in several centres around the world.

Nocturnal Home Haemodialysis is now a viable treatment. This slower, gentler treatment gives patients several benefits as the above research suggests. When dialysis is provided over a longer period, fluids are removed more slowly, which results in a more gentle treatment for most patients.

Image curtesy of BillpSea

Studies also suggest that night-time dialysis patients may be able to:

• Better control their blood pressure and mineral levels, resulting in fewer dietary restrictions, which allows them to eat a wider variety of foods.
• Leading in turn to a better quality of life for these victims of renal failure - they do not feel as washed out after treatment for example.
• It can be less expensive overall, as patients are hospitalised less frequently due to medical problems.
• It also seems that these patients tend to live longer.

Indeed industry giant Fresenius now offers such treatments at its clinics - over 140 of their clinics offer this in North America (as of 1st May 2013) and the option is proving to be popular.

Although we have been talking about nocturnal haemodialysis, nocturnal peritoneal dialysis is also a viable treatment.

Disadvantages - despite the above advantages patients may have problems or worries.

• Training is required, and courses usually run during working hours.
• Home dialysis can impact of the family life.
• The machine does take up a bit of space.
• Increased electricity costs.
• For couples, there can be sleep loss problems if the machine's alarm goes off.
• Patients often think they can't carry out this treatment, and may be worried about working with needles and cannulas. This is often a problem for the more frail and elderly patients.
• Patients tend to believe hospital treatment must be better.

But let's not forget the advantages listed above - don't they outway these possible disadvantages?