Better Kidney Health While You Sleep

Kidney disease patients may improve both kidney health and artery function with overnight dialysis

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) For patients with end-stage kidney disease, heart problems are common. Overnight dialysis in the home to rid the blood of toxins may help lower heart disease risk in these patients.

With end-stage renal disease (ESRD), a patient’s kidneys can no longer function on their own, and they either need dialysis or a kidney transplant to sustain day-to-day life. Dialysis uses a machine to filter wastes, salts and fluids from the blood.

Dialysis can be time-consuming, but a new study has found that patients who receive the treatment at home while they sleep may have improved coronary artery function compared to those who get conventional dialysis in a clinic or hospital.

"Look into overnight dialysis treatment to treat kidney disease."

Christopher Overgaard, MD, an interventional cardiologist at the Toronto General Hospital, and colleagues observed the effects of home dialysis compared to conventional dialysis in patients with ESRD.

Home dialysis can be performed as patients sleep, six times a week, for up to 12 hours at a time, for up to 72 hours a week. Traditional hemodialysis usually requires that a patient receives treatment three times a week for three or four hours at a time. This is called intermittent hemodialysis (IHD).

Dr. Overgaard and team followed 17 patients, with an average age of 51, who required coronary angiography, a screening test that uses dye and special x-rays to view blockages in the arteries.

Six ESRD patients received the standard intermittent hemodialysis (three four-hour sessions per week for an average of 24 months), and six other ESRD patients received nocturnal hemodialysis (six 12-hour sessions per week for an average of 31 months). A comparison (control) group of five did not have ESRD.

Dr. Overgaard and his fellow scientists evaluated endothelial responsiveness in these patients. The endothelium is the thin layer of cells that lines the interior surface of blood vessels.

Those with kidney disease often have impaired endothelial function, meaning their blood vessels have a decreased ability to widen. That may put them at greater risk of having narrowed or clogged arteries (atherosclerosis).

The researchers gave patients acetylcholine (ACh), a chemical compound that widens blood vessels. The control group had expanding of the blood vessels, while the intermittent hemodialysis patients had narrowing blood vessels. While the nocturnal hemodialysis group also had narrowing, it was less than that of those receiving intermittent hemodialysis.

Based on patient reactions to ACh, the authors wrote, “Coronary endothelial responsiveness is markedly impaired in [intermittent hemodialysis] patients, an effect that is partially normalized with nocturnal hemodialysis.”

With nocturnal dialysis, toxins are more evenly and gently removed from the blood because of the frequency and duration of overnight dialysis, according to the authors.

“Increasing the number of hours patients receive their treatment results in less toxin buildup in their blood for shorter durations,” said Dr. Overgaard in a press release. "This method also improves quality of life by having the dialysis in the comfort of your home, while sleeping, instead of being stuck in a dialysis unit for hours. Old-fashioned dialysis is stressful."

Home dialysis has been growing in popularity in recent years. National Kidney and Urological Disease Information Clearinghouse (NKUDIC) says that new dialysis machines are smaller and easier to use in the home. The overnight approach lends further support to home dialysis.

NKUDIC states that there may be some barriers to home dialysis. For example, Medicare and insurers that pay for hemodialysis provide a set payment based on a standard schedule of three treatments a week, according to NKUDIC. Also, home care requires being able to recognize problems and react fast when they arise.

This study was presented in October at the Canadian Cardiovascular Congress, which is co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society. All research is considered preliminary until published in a peer-reviewed journal.

Review Date: 
October 22, 2013
Last Updated:
October 23, 2013