Home Dialysis May Reduce Risk of Heart Disease

In addition to improving kidney health and quality of life, receiving dialysis at home while sleeping could also decrease the risk of heart disease for patients with end-stage renal disease, according to a new study recently presented at the Canadian Cardiovascular Congress in Montreal. Conventional hemodialysis typically involves going to a clinic to receive 3- to 4-hour sessions of treatment 3 times a week.

With overnight hemodialysis, patients can receive dialysis 6 times a week, up to 12 hours at a time, for up to 72 hours—without having to leave home. This convenience affords patients receiving overnight dialysis improvements in quality of life in addition to clinical benefits.

Patients with end-stage renal disease have at least a five-fold increase in cardiovascular complications, according to study author Christopher B. Overgaard, MD, MSc, FRCPC, medical director of the coronary intensive care unit at Toronto General Hospital. He says longer dialysis, administered while patients are sleeping, could improve the health of arteries and lower the risk of developing heart disease.

Dr Overgaard and colleagues studied 17 patients, ages 27 to 66, who required diagnostic coronary angiography—5 controls who did not have end-stage renal disease, 6 who were receiving conventional intermittent hemodialysis, and 6 who underwent nocturnal home hemodialysis.

After patients transitioned from conventional hemodialysis to at-home overnight dialysis, the researchers saw improvements in their coronary artery function. Co-author Christopher Chan, MD, the R. Fraser Elliott Chair in Home Dialysis and medical director of Home Hemodialysis for University Health Network in Toronto, says their previous work has shown that patients with end-stage renal disease with the following co-morbid illnesses benefit from nocturnal hemodialysis:

• Hypertension

• Left-ventricular hypertrophy

• Hyperphosphatemia

• Sleep apnea

• Heart failure

• Significant interdialytic weight gain

“Family MDs play an ‘identifier role’ in referring patients to nephrologists to manage their patients with end-stage renal disease and cardiologists to manage associated cardiac issues,” Dr Overgaard says. “If they have an understanding of various modalities, such as nocturnal dialysis, peritoneal dialysis, traditional hemodialysis, and renal transplant, they may be able to refer patients to specific renal specialists with a particular expertise in their region.”

—Colleen Mullarkey

Reference

Overgaard CB, Chan W, Chowdhary S, Zur RL, Morrison L, Bui S, et al. Nocturnal hemodialysis restores impaired coronary endothelial function in end-stage renal patients receiving conventional hemodialysis. Can J Cardiol. 2013 Oct;29(10):S286.