Nocturnal Dialysis Boosts Kidney Health

Nocturnal home hemodialysis (NHD) improves kidney health as well decreasing the risk of heart disease by restoring impaired coronary endothelial responsiveness, according to a new study.

Researchers at Toronto General Hospital (TGH; Canada) examined 17 patients, which included 6 NHD patients, 6 receiving conventional intermittent hemodialysis (IHD), and five controls that required diagnostic coronary angiography (CA). The IHD patients had been on dialysis for 24 months, receiving three 4-hour sessions per week, while the NHD patients received six 12-hour sessions per week. Following angiography and systemic heparin, the researchers measured drug-induced changes in mean luminal diameter (MLD), expressed as a percentage increase from baseline measurement.

The results showed that coronary endothelial responsiveness is markedly impaired in IHD patients, an effect that is partially normalized with nocturnal hemodialysis. The researchers also found that free-radical scavenging with Vitamin C partially restores endothelial function in IHD, but not NHD or control subjects, suggesting that greater oxidative stress in IHD patients may contribute to the impaired endothelial responsiveness. The study was presented at the Canadian Cardiovascular Congress, held during October 2013 in Montreal (Canada).

“Patients with end-stage renal disease have at least a five-fold increase in cardiovascular complications,” said study coauthor cardiologist Christopher Overgaard, MD. “Longer dialysis done while patients are sleeping may improve the health of arteries and could lower the risk of developing heart disease.”

When patients with accelerated atherosclerosis in end-stage renal disease (ESRD) under an IHD regimen are converted to NHD, they experience a rapid (1-2 months) increase in dialysis dose, restoring both absent brachial artery endothelium-dependent hyperemia and markedly impaired endothelium-independent vasodilatation.

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