ARTICLE - Night-time hemodialysis improves heart disease

Discussions for Patients, Family, and Friends HD For Patients
1

Hi y’all,

I wanted to share this press release on a new article comparing nocturnal home hemo to conventional in-center hemo & to healthy people. Please note that all italics, bold, and bullets are mine. Also, Dr. Chan very kindly summarized several other key papers for Home Dialysis Central–you can read his summary at: http://www.homedialysis.org/v1/research/articles/20051007.shtml Dori

Night-time Hemodialysis Improves Heart Disease in Patients with ESRD
on Tuesday, October 11 @ 13:39:45 EDT

Patients may have a greater capacity to repair their hearts and blood vessels compared to those on conventional dialysis three times a week.

“This study paves the way for new therapeutic targets which can potentially improve heart disease in patients with end-stage kidney failure,” said Christopher T. Chan, the lead author of the study entitled “Nocturnal hemodialysis is associated with restoration of impaired endothelial progenitor cell biology in end-stage renal disease.” Chan is a nephrologist at Toronto General Hospital (TGH) University Health Network, as well as the medical director of the Home Hemodialysis Program at TGH and assistant professor of medicine, University of Toronto.

This study specifically examined endothelial progenitor cells (EPCs) which reside in the bone marrow and contribute to the regeneration and repair of blood vessel walls, and may well play a significant role in generating new blood vessels at the site of an injury. Studies have shown that an infusion of EPCs into the heart after a heart attack or into limbs that have constricted blood flow do improve blood flow and aid in healing injured tissue.

“Endothelial progenitor cells are like ‘handymen’ entering the bloodstream to get into areas of blood vessel injury to help repair the damage which occurs on a daily basis,” Chan explained, adding that depletion or reduced function of these cells likely contributes to blood vessel disease. “If we can manipulate EPCs to directly target vascular and cardiac injury, we may unlock an important mechanism by which we can address the high cardiovascular morbidity and mortality of this patient population,” Chan said.

The study found that there was a five-fold decrease in EPCs in patients on conventional dialysis compared to the healthy participants and the patients on night hemodialysis. Moreover, patients on conventional hemodialysis also had higher blood pressure than patients on night-time dialysis (mean of 143 vs.128) and significantly higher left ventricular mass index (LVMI) scores, indicating abnormal left ventricular heart mass.

Chan and Verma studied and compared three groups of patients cross-matched for age, gender, and reasons for dialysis: 12 conventional dialysis patients, 10 nocturnal hemodialysis patients and 10 healthy patients who do not need dialysis.

The four key outcome measures included:
• Numbers of EPCs circulating in the blood stream
• Migration function of these cells, measuring whether the cells were able to migrate into the blood stream to get to an injury site
• LVMI, which measures the weight of the heart (a thickened heart cannot pump blood efficiently and results in eventual heart failure);
• Blood pressure.

Results on all measures showed a significant difference between the patients on conventional hemodialysis and the two other groups: those patients receiving night hemodialysis and the healthy control group. Compared with the healthy participants and the ones on night hemodialysis, EPC number and migration function were markedly impaired in conventional dialysis patients, along with a poorer LVMI and higher blood pressure. In contrast, EPC number and migration function were normal in night-time dialysis patients.

“These results show that with night-time dialysis, the numbers and function of these specific cells are similar to our healthy study participants,” said Chan, “and given the critical importance of these cells in vascular repair and regeneration, this study adds support to the growing evidence of cardiovascular benefits of night-time hemodialysis.”

Chan noted that nocturnal hemodialysis is the more optimal therapy for patients with end-stage renal disease since it more closely mimics what our own kidneys do in our bodies.

The increased frequency and duration of night hemodialysis (about six sessions per week, approximately 8 hours per session) has previously shown to improve blood pressure, lower use of anti-hypertensive medications and improve cardiovascular measures compared to patients on conventional dialysis. Additionally, patients on the thrice-weekly conventional dialysis (about four hours per session) have complications such as abnormal thickness of the heart, low energy and retention of fluids in the body, necessitating a strict diet and liquid-intake regimen.

TGH currently has 67 patients on nightly home hemodialysis, making it one of the largest programs in the world. Patient training for nightly home hemodialysis takes from six to eight weeks, and includes hands-on learning about the dialysis machine, medications, problem-solving in the event of a machine malfunction, IV medications and blood work.
October issue of the American Journal of Physiology–Renal Physiology, published by the American Physiological Society. <<http://www.the-aps.org/>http://www.the-aps.org/>

2

Hi Dori,
Just thought you might like to know that my husband just had an echo done and the cardiologist was astonded that his heart is much better than it was a year ago.
Pat

3

I had already seen the most recent study abstract, but it was interesting to read Dr Chan’s summary. As a daily nocturnal hemo patient, I have to say that of the things I can see or measure myself, my experience after 6 months has been very much as described.

People often ask me how I can feel safe sleeping all night while blood is being circulated outside my body. Well, it’s like this. For every medical treatment or procedure, there are risks and there are benefits. Consideration of risks versus benefits is being done all the time, every single day. The main reason which prompted me to ask for a switch to daily nocturnal a year ago was precisely the cardiovascular benefits- because with my own history, my age and my family history, I would surely be among the higher risk patients. So I’m glad to see more published evidence of that. The way I figure it, I’m safer in my bed at night while on dialysis at a low UF rate, low blood pump speed and low dialysate pump speed than I would be all of the time, at home or at the dialysis centre doing dialysis 3 times per week.

When I talk about my blood pressure being normalized to about 120/75, it has to be taken in the context of someone who has had severe, treatment-resistant high blood pressure problems for a good 15 years. So, the fact that daily nocturnal has normalized it without medication is truly amazing. Yes, in terms of blood pressure, you can always find some example of someone who is doing Ok on thrice-weekly hemo, or on short daily hemo. But these people are exceptions to the rule.

Even though I have to do the treatment 6 nights per week, it’s actually very liberating. All my days are free, and I can eat whatever I want and in practical terms, drink as much as I need to. Another benefit is that hemoglobin goes way up without changing the dose of EPO. By way up, I’m talking about 110-115 to about 128-130. That has got to make a big difference in how a person feels, and it does for me.

Once you’ve tried daily nocturnal and you compare, there’s just no going back unless you’re forced to do so for some reason.

Pierre

4

I hope that someone has shared this study with the powers that be at the Centers for Medicare and Medicaid Services or at least is looking into the cost benefits related to improvement in cardiac status sooner than the NIH study results will be reported many years from now. A lot of Medicare dollars are spent on cardiac care for people on dialysis. You’d think the increased cost for extra nights of dialysis might just be offset by spending less on cardiac care not counting the reduced needs for medicines which may be even an important savings now that Medicare is going to be paying for take-home drugs starting on January 1, 2006.

5

Hi y’all,

Pat, I’m delighted to hear that your husband’s heart has improved, that’s fantastic news!

I also wanted to let everyone know that this week’s “Innovative Paper” is on the cardiac benefits of short daily hemo. You can read it at: http://www.homedialysis.org/v1/research/articles/20051014.shtml.

6

how is nightly HD done i’m new to all of this and need info on all types of HD since PD it out of the ? for me.

7

You’re in luck, drinkardckd. We have information about all of the types of dialysis and where to get them right here on this site. You can learn about the types here: http://homedialysis.org/types and see the equipment here: http://homedialysis.org/types/equipment/. Find a clinic here: http://locater.homedialysis.org/.

Or, you may want to check out the new book I wrote with Dr. Agar (he answers questions in our Expert Boards), called, Help, I Need Dialysis!. We wrote it especially for people who are facing a need for dialysis and are scared. It’s easy to read and will explain how each type of dialysis works–and what it would mean for everything in your life from what you can eat and drink to how well you might sleep, whether you can work or travel, how your sex life might be affected, and even how long you might live. It’s $14.99 and you can order it here: http://www.lifeoptions.org/help_book

8

[QUOTE=Dori Schatell;22475]You’re in luck, drinkardckd. We have information about all of the types of dialysis and where to get them right here on this site. You can learn about the types here: http://homedialysis.org/types and see the equipment here: http://homedialysis.org/types/equipment/. Find a clinic here: http://locater.homedialysis.org/.

Or, you may want to check out the new book I wrote with Dr. Agar (he answers questions in our Expert Boards), called, Help, I Need Dialysis!. We wrote it especially for people who are facing a need for dialysis and are scared. It’s easy to read and will explain how each type of dialysis works–and what it would mean for everything in your life from what you can eat and drink to how well you might sleep, whether you can work or travel, how your sex life might be affected, and even how long you might live. It’s $14.99 and you can order it here: http://www.lifeoptions.org/help_book[/QUOTE]

Dori and Dr. Agar’s book is absolutely wonderful. It goes into detail that you can understand about the different options we have as well as many other great topics to learn. This is a great tool for educating and advocating for yourself. After reading this book, you will be ready to ask the proper questions to your medical team. I have found that the more I learn on my own and the more I question the medical team, the more information they openly tell me without asking.

I believe this book is a must!!! My opinion is that the book should be in every waiting room at every dialysis center as well as in the treatment area for the patients to read… Not to mention given to every new patient that steps into the nephrologists office.

If there was only a way to get the resources to purchase and send these books to the different centers…

///MM

9

You might want to start the ball rolling by talking it up to your doctor and the home training nurse at your dialysis clinic as well as to any patinets and staff you know. They may just pass on the word to others. Last week I posted a suggestion to the social work listserv that the book could be in their clinic library and their doctors’ offices.