Dialysis At Home Improves Patient Outcomes?
An article in the current issue of the Journal of the American Medical Association evaluated the use of nocturnal dialysis as opposed to conventional dialysis for patients with end-stage renal disease (ESRD), comparing the resulting effects on left ventricular mass and life quality. Data from a two year project suggests that nighttime treatment offers benefits for other co-existing conditions.
52 patients were randomized to receive one of the two treatment options between August 2006 and December 2006. Each patient was treated with the specified option over a six month period at one of two different facilities in Canada. The study was funded, in part, by the Kidney Foundation of Canada.
Data from the study reveals that treating patients overnight, six nights per week, is associated with shrinkage to left ventricular masses. Masses decreased by an average of 13.8 grams in the nocturnal, home-based group whereas patients treated with conventional dialysis had an increase of the left ventricular mass, averaging 1.5 grams. This is a common condition among patients with kidney disease, who often have significant co-morbidities.
Other benefits noted among the nocturnal group was a stabilization in systolic blood pressure and mineral metabolism. Some patients were able to either reduce or discontinue antihypertensive therapies and oral phosphate binders secondary to these improvements. Again, this finding was in the group treated overnight.
The Canadian research team also indicated that nocturnal therapy has the potential to improve patients’ quality of life related to the kidney disease. However, there were not significant differences in overall life quality between the two treatments. Two editorials, which accompanied the research report, advocated for continued trials to evaluate the two treatment options.
There has been some resistance to widespread adoption of at-home or alternate site dialysis. Some argue the resistance is a function of reimbursement rates, which offer a high rate for facility-based treatment. Clinicians who treat patients with end stage renal disease have been awaiting evidence that more closely assesses outcomes with home-based treatment. This study is one of the first comparisons of the two options.
2003 data from Canada, published by the International Society of Nephrology, indicates that treatment at home can be 20 percent less expensive then treatment at dialysis centers. That is dramatic savings, particularly for a condition that is costs Medicare more than $20 billion annually. Continued research is required to investigate if the benefits in outcomes and cost savings warrant altering the delivery of dialysis.
September 20, 2007 Related topics: Trends, Renal & Urology