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Nutritional status after conversion from conventional to in-centre nocturnal hemodialysis

  • Nephrology – Original Paper
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Abstract

Introduction

Recipients of conventional hemodialysis (CHD; 3–4 h/session, 3 times/week) experience volume expansion and nutritional impairment which may contribute to high mortality. Prolongation of sessions with in-centre nocturnal hemodialysis (INHD; 7–8 h/session, 3 times/week) may improve clinical outcomes by enhancement of ultrafiltration and uremic toxin removal.

Materials and methods

In this prospective cohort study, 56 adult patients who were receiving maintenance CHD for at least 90 days were assigned to CHD (patients who remained in CHD) and INHD (patients who switched to INHD) groups. Both groups were followed for 1 year divided into four 13-week quarters; post-dialysis weight and interdialytic weight gain (IDWG) were captured in each quarter. Repeated measures analysis of variance was used to calculate group main effect, time main effect or time–group interaction effect.

Results

Conversion to INHD was associated with a mean (95% confidence interval) change in IDWG of 0.5 (0.08, 1.2) kg as compared to −0.3 (−0.9, 0.1) kg in the CHD group (p < 0.01). In the INHD group, post-dialysis weight (% of baseline pre-dialysis weight) decreased after conversion, reaching a nadir during the first 3 months (0.7%) and subsequently it gradually increased and returned to its baseline at the end of follow-up. A similar temporal trend was seen for serum creatinine but not serum N-terminal pro-brain natriuretic peptide (NT-proBNP) which is a marker of extracellular volume. The changes in serum albumin, prealbumin and hs-CRP were not different between the two groups.

Conclusions

Conversion to INHD was associated with greater IDWG and relatively stable body mass. We speculate that this gain in weight reflects an increase in lean body mass following the change in dialysis modality, which can be concluded from the parallel increase in serum creatinine and the lack of increase in NT-proBNP.

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Acknowledgements

The investigators appreciate the special efforts of our patients who made this research possible. We are also grateful for the hard work of our research assistants Galo Ginocchio, Mauricio Medrano and Lina Sioson. These data were presented in part at the American Society of Nephrology Kidney Week (Atlanta, Georgia, November 2013).

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Authors and Affiliations

  1. Division of Nephrology, St. Michael’s Hospital, 140-61 Queen Street East, Toronto, ON, M5C 2T2, Canada

    Nazanin Noori, Andrea Rathe, Marc B. Goldstein & Ron Wald

  2. Division of Cardiology, Department of Medicine, St. Michael’s Hospital, Toronto, ON, Canada

    Andrew T. Yan & Olugbenga Bello

  3. Li Ka Shing Knowledge Institute, ST. Michael’s Hospital, Toronto, ON, Canada

    Andrew T. Yan, Marc B. Goldstein & Ron Wald

  4. Division of Nephrology, St. Paul’s Hospital, Vancouver, BC, Canada

    Mercedeh Kiaii

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  1. Nazanin Noori
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  2. Andrew T. Yan
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  3. Mercedeh Kiaii
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  4. Andrea Rathe
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  6. Olugbenga Bello
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  7. Ron Wald
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Correspondence to Ron Wald.

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Noori, N., Yan, A.T., Kiaii, M. et al. Nutritional status after conversion from conventional to in-centre nocturnal hemodialysis. Int Urol Nephrol 49, 1453–1461 (2017). https://doi.org/10.1007/s11255-017-1595-x

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  • DOI: https://doi.org/10.1007/s11255-017-1595-x

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