End Stage Renal Disease (ESRD) patients are prone to malnutrition manifested as low albumin, low normal Protein Catabolic Rate (nPCR) and decreased protein and calorie intake. Albumin correlates strongly with mortality rates of patients with ESRD. Daily hemodialysis shows significant improvement in all nutritional parameters for ESRD patients.
Nocturnal hemodialysis is effective in phosphate removal related to long duration and high frequency of dialysis. The weekly phosphate removal in the dialysate was twice as high compared to conventional hemodialysis. In these patients serum phosphate normalizes within 1-2 weeks after the initiation of nocturnal dialysis and phosphate binders are discontinued in all patients. In short daily dialysis patient's phosphate control is better than on conventional hemodialysis with a decreased use of phosphate binders.
Serial bone density measurements after 6-12 months in all nocturnal patients have determined a progressive decrease in bone density during early phases of clinical studies. This indicates an increase requirement of dialysate calcium to prevent further bone loss and to restore bone density. All nephrology nurses are expected to understand the cause, treatment and potential consequences of uremia of the skeletal system. Unfortunately, because bone disease in ESRD patients is a slow-developing manifestation, the more urgent issues of providing adequate dialysis, monitoring and controlling blood pressure and controlling anemia take priority.
In addition, because of the slow and frequent nature of nocturnal dialysis, patients are much less likely to have serious heart problems than those on "conventional" three times a week treatments. These patients can attain normal blood pressure and maintain near normal body water, as a result they are more likely to have a normal heart size as the heart is not overloaded with excess body water and the usual stretching of the heart seen with conventional trice weekly dialysis. Kidney failure often leads to a thickened heart that cannot pump blood efficiently and eventually fails. By impacting the heart, one can ultimately improve the patient's survival rate. Dialysis patients frequently have Cardiovascular Disease, with left ventricular hypertrophy, thickening of the heart muscle in response to fluid or pressure overload that are so common in most patients. Both types of modalities short daily dialysis and nocturnal treatments have shown improved hematocrits (Hct) or Hemoglobin (Hgb) and thus reduce use of erythropoietin (EPO) resulting in medication cost savings.
In the case of Nocturnal daily hemodialysis, patients have shown a marked improvement in Blood Pressure (BP) with an elimination or reduction in BP antihypertensive medication requirements.
Research has also found [link to article] that sleep apnea common to patients with chronic renal failure is improved with nocturnal dialysis. This results in a marked improvement in patient's quality of life. Sleep apnea a condition where people stop breathing during sleep occurs in up to 50 per cent of those on dialysis. Sleep apnea may also increase a patient's risk of developing cardiovascular disorders such as hypertension, coronary artery disease and stroke. When training patients for daily home hemodialysis our approach is to teach the patients with a fistula to use the buttonhole technique for cannulation.
