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Ten Years Experience of In-Center Thrice Weekly Long Overnight Hemodialysis

Joanna Ruth Powell^*, Oyeniran Oluwaseun^*, Yook Mun Woo, Neal Padmanabhan^*, Eliyanachii Narasinghan, Carol Latta^*, Julie Tortolano, Alan G. Jardine^*,, and Colin C. Geddes^*

^* Renal Unit, Western Infirmary, Glasgow, United Kingdom; Renal Unit, Inverclyde Royal Infirmary, Greenock, United Kingdom; Department of Medicine, University of Glasgow, Glasgow, United Kingdom

Correspondence: Joanna Ruth Powell, Renal Unit (Level 7), Western Infirmary, Dumbarton Road, Glasgow, United Kingdom, G11 6NT. Phone: 0141 211 2178; Fax: 0141 211 1711; E-mail: Joanna.Powell{at}ggc.scot.nhs.uk

Background and objectives: Published studies suggest that longer hemodialysis (HD) sessions are associated with improved morbidity and mortality, but few centers offer long sessions. The Western Infirmary renal unit has offered long overnight hemodialysis (LOH) (6 to 7 h) thrice weekly since 1998. The aim of this study was to describe patients who chose LOH and compare outcomes with patients on conventional hours (4 to 5 h) HD.

Design, settings, participants, & measurements: Patients who ever had LOH for three or more consecutive sessions were identified (n = 146). Indices of urea reduction ratio (URR), anemia, hyperphosphatemia, and predialysis BP (BP) control in a subgroup of all patients on LOH for at least 1 yr since 2004 were compared with age, sex, and diabetes-matched controls undergoing conventional duration HD.

Results: The mean age at the time of starting LOH was 51.8 yr and 74.7% started with a functioning arteriovenous fistula. Median duration of continuous LOH was 1.6 yr. Of those no longer on LOH, only 33.3% reverted to conventional hours HD (mean duration LOH 2.2 yr). When comparing LOH and conventional HD cohorts, there was increased URR and mean hemoglobin with a trend toward lower mean erythropoietin index. There was a trend toward fewer phosphate binder tablets but no difference in mean serum phosphate, BP, or number of prescribed antihypertensive medicines.

Conclusions: LOH is a well tolerated hemodialysis option, associated with improved URR and better control of anemia.