Study: Clinical and Operational Results of In-Center Nocturnal Hemodialysis Programs in a Large Dialysis Organization

In-center nocturnal hemodialysis (INHD) offers a combination of treatment efficacy, safety, and improved treatment tolerability. Recognizing the specific clinical and laboratory results that indicate INHD might be beneficial for a given patient requires an understanding of modality-specific therapeutic differences. Therefore, DaVita Kidney Care team examined the operational characteristics of INHD programs, as well as compared laboratory and clinical parameters between INHD and in-center hemodialysis (ICHD) patients (i.e., those receiving daytime dialysis).

Data for this study were derived from the electronic health records of adult (≥ 18 years of age) patients within the US who received INHD or ICHD treatments between 01 Jan 2018 and 31 July 2019. Distributions of patient demographic information, dialysis prescription data, clinical laboratory markers, blood pressure and target weight for INHD and ICHD patients were compared using box plots. Hospital admissions were calculated as rates and compared between INHD and ICHD patients. Comparisons were not adjusted for differences in patient characteristics or pre-dialysis care between groups.

During the study period, 2452 patients were treated in 163 INHD programs. The mean age of INHD patients was 52 years; 28.8% were female; access use was 69.2% by arteriovenous (AV) fistula, 15.5% AV grafts, 10.7% central venous catheters, and 4.6% other. Mean INHD program census was 9 patients, mean operating time was 8.9 hours/shift and staff retention rate was 83%

Laboratory values and clinical characteristics in INHD and ICHD patients are described below.

• Median albumin values were 3.8 and 4.0 mg/dL among ICHD and INHD patients, respectively.
• Median dialysis adequacy (Kt/V) values were 1.5 and 1.9 among ICHD and INHD patients, respectively.
• Median urea reduction ratios were 73 and 78 among ICHD and INHD patients, respectively.
• Median ultrafiltration (UF) rates were 7.0 and 5.0 mL/kg/hr among ICHD and INHD patients, respectively.
• The hospitalization rates were 1.78 and 1.55 admits per patient year among ICHD and INHD patients, respectively.

In summary, compared with ICHD, dialyzing with INHD was associated with:

• Improved nutritional parameters
• Improved solute clearance
• Lower UF rates
• Lower hospitalization rates

Patients receiving standard ICHD who are not achieving risk factor control, are experiencing increased organ stunning risk with elevated UF rates, or with hemodynamic instability may be good candidates for INHD and should be evaluated to determine whether a transition to INHD is appropriate

For more information, read the research poster (which was presented at ASN), here.