Nocturnal dialysis: Comparing six night/week with alternate night therapy

The biochemical, haemodynamic, clinical, and nutritional benefits of nocturnal haemodialysis (NHD) compared with (c/w) 4 hr, 3/week conventional haemodialysis (CHD) are well known and accrue by increasing dialysis time and frequency either for 8 hrs alternate night/week (NHD_3.5) or for 8 hrs 6 nights/week NHD (NHD₆). However, there is little data yet comparing NHD_3.5 with NHD₆. 13 NHD₆(8.15 hrs/night) were c/w 14 NHD_3.5(7.8 hrs/night), all with similar demographic profiles. NHD₆ had unrestricted diet and fluid intake but NHD_3.5 needed some restriction. Before (_b) and after (_a) HD phosphate (PO₄) control was ideal though _bPO₄ levels for NHD₆ were lower (1.64 mmol/l) c/w NHD_3.5(1.83 mmol/l). All NHD₆ needed PO₄ supplementation c/w 2/14 NHD_3.5 but 5/14 NHD_3.5 needed PO₄ binders c/w 0/13 NHD₆. Both had normal blood pressures with 3/14 NHD_3.5 needing anti‐hypertensives c/w 2/13 NHD₆. The _bHb was 122.8 g/l (NHD₆) c/w 127.7 g/l (NHD_3.5) and the _balbumin was 38.3 g/l (NHD₆) c/w 37.7 g/l (NHD_3.5). NHD₆ had lower _b blood urea (10.2 c/w 19.5 mmol/l) and less interdialytic urea and creatinine fluctuation. NHD₆ ultrafiltration rates (UFR) and intradialytic weight gains (mean ± SEM) were significantly lower (248 ± 22.7 ml/hr and 2.03 ± 0.19 kg) c/w NHD_3.5(453 ± 34.6 ml/hr and 2.85 ± 0.27 kg): UFR p < 0.10. We conclude that NHD₆ offers the optimum biochemical, volume, and clinical outcome but NHD_3.5 still has a clear and major advantage over CHD and a dual additional appeal to providers seeking home‐based therapy cost advantages and consumable expenditure control. A flexible dialysis program should offer all the time and frequency options of NHD but, in particular, should support NHD at a frequency sympathetic to the clinical, rehabilitation, and lifestyle aspirations of individual patients.