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| |  Nocturnal Haemodialysis Versus Conventional Haemodialysis for Better Blood Pressure: Presented at ASN By Bryan DeBusk, PhD SAN FRANCISCO, CA -- November 6, 2007 -- Patients switching to nocturnal haemodialysis (NHD) have lower blood pressure and lower left ventricular (LV) mass compared with the counterparts on conventional haemodialysis (CvHD), resulting in a reduction or elimination of antihypertensive medications. Bruce F. Culleton, MD, Research Scientist, Baxter Healthcare, Deerfield, Illinois, United States, reported the findings here at Renal Week 2007, the American Society of Nephrology (ASN) Annual Meeting. Dr. Culleton and his colleagues randomised 52 patients (mean age 54 years, 37% female) to either NHD or CvHD. Patients in the CvHD group continued their 3-times-per-week haemodialysis protocols at the time prescribed, and NHD patients received training prior to commencing a course of NHD 5 to 6 nights per week for 6 to 8 hours per session. One patient in the NHD group refused all study-related procedures and dropped out of the study prior to training. Three other patients dropped out over the 6-month study (2 CvHD patients received transplants and 1 NHD patient died). At the outset of the study, both groups had similar systolic blood pressure (sBP), similar LV mass as determined by MRI, and similar use of antihypertensive medications. At the conclusion of the study, sBP had improved in the NHD group (+7 mm Hg) and worsened in the CvHD group (-4 mm Hg) for a combined difference of 11 mm Hg (95% confidence interval [CI], -2 to 24). This difference persisted despite the reduction in dose or elimination of antihypertensive medications in 16 of the 26 NHD patients (compared with reduction or elimination in 3 of 25 CvHD patients, P <.001). LV mass was also reduced in the NHD group compared with the CvHD group (15.3-g difference; 95% CI, 1.0-29.6; P =. 037), and when LV mass was adjusted for starting LV mass and sBP, the difference was greater (19.7-g difference; 95% CI, 4.5-34.8; P =.013). Dr. Culleton noted that only about 10% of patients undergoing dialysis at the participating centre were interested in NHD, but he remarked that even with this relatively small proportion of the dialysis population expressing interest, "Expansion of NHD centres should be considered specifically for patients who wish to trade off a more demanding therapy for less cardiovascular risk."
[Presentation Title: Nocturnal Hemodialysis Lowers Blood Pressure and Reduces Left Ventricular Mass: Results of a Randomized Controlled Trial. Abstract SU-FC002]
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