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Nighttime Home Dialysis a Boon for Kidney Patients
Date:9/18/2007

quent nocturnal dialysis might improve heart health and other results, but no randomized clinical trials had been done comparing the standard dialysis regimen to the at-home treatment.

Culleton and his colleagues recruited 52 dialysis patients and randomly assigned them to receive either conventional dialysis three times a week at a dialysis center or to learn at-home dialysis to be done five to six times a week for at least six hours while they were sleeping.

By the end of the six-month study period, the average left ventricular mass was 15.3 grams more for the conventional dialysis group, compared with the nocturnal dialysis group.

"These patients clearly did have improvements in heart thickness, and other studies have shown that if you reduce the size of the left ventricle, you increase survival," said Dr. Alan Kliger, chairman of medicine at the Hospital of St. Raphael and a clinical professor of medicine at Yale University School of Medicine. Kliger wrote an accompanying editorial in the same issue of the journal.

In addition to the reduction in left ventricular mass, blood pressure dropped as well for the nighttime dialysis group. Systolic blood pressure -- the top number -- went down 7 mm/Hg for the nocturnal dialysis group, compared to a 4 mm/Hg increase for the conventional group. Diastolic blood pressure also dropped 7 mm/Hg for those dialyzing at home, but decreased just 2 mm/Hg for the standard group.

Sixteen out of 26 people in the nocturnal dialysis group were able to stop taking high blood pressure medications, while only three out of 25 in the standard group stopped these medications.

There were also improvements in mineral metabolism, such as calcium and phosphate, and some improvements in quality of life, such as the burden of kidney disease, in the nightly dialysis group.

Both Culleton and Kliger said these improvements were the result of more frequent dialysis for the at-home
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