Vanderbilt University Medical Center, committed to providing multiple options to patients who have kidney disease, recently began offering nocturnal in-center hemodialysis, which allows patients to receive treatment at night while they sleep.
With their days free of dialysis treatments, patients can go to work, attend school, take care of family members and do what they were doing during the day before they started dialysis.
“The nighttime treatment is a slower process and is easier on my body. The four-hour daytime dialysis is kind of hard on the body and the recovery is more difficult,” said Emilio Hughes, who has been undergoing nocturnal hemodialysis for about a year. “At first it was kind of difficult to go to sleep, but now it’s easier to doze off.”
The nocturnal in-center hemodialysis program began in May 2013 and is offered at the Vanderbilt East Dialysis Unit on Rachel Drive, near the Nashville International Airport.
“Vanderbilt tries to provide the broadest range of care in the safest and most effective way for patients,” said Ray Harris, M.D., Ann and Roscoe R. Robinson Professor of Medicine and chief of the Division of Nephrology. “We spent a year in planning and training our team to have all the fail-safe steps in place. We wanted to make this work effectively and safely for patients, which took a great deal of logistical planning. It’s the sort of effort that will pay off for the patients.”
The nocturnal unit is open on Sunday, Tuesday and Thursday. A nurse and a technician begin a patient’s dialysis treatment between 7 and 9 p.m. They dim the lights, and most patients drift off to sleep and awaken eight hours later when the treatment is complete.
“Although multiple large observational studies in several countries have shown a connection between longer treatment times and better survival, there is no randomized trial confirming this result. So even though there are still questions about whether patients who dialyze for more hours each week live longer, it is clear that there are quality-of-life improvements for patients who dialyze for eight hours, three nights a week,” said Rachel Fissell, M.D., assistant professor of Medicine.
“For example, it is wonderful for our team to be able to encourage our patients to eat and drink more, without worrying so much about fluid gains between treatments. It is also wonderful to see the patients have their days free of dialysis to go to school, work and just generally be able to live their lives.”
Hospitalizations and mortality from cardiovascular disease are high in dialysis patients. During nocturnal treatment, fluid is removed more slowly and over a longer period of time, so the treatments are easier on the heart. More fluid can be removed, but without the low blood pressure and cramping that can occur in patients who receive a three- or four-hour hemodialysis treatment.
Nocturnal dialysis is a practical way for patients to achieve more hours of treatment time per week. Longer treatments remove more molecules, such as phosphorus, so patients can liberalize their diets, eat more and still have phosphorus levels that are within a healthy range.
Vanderbilt also offers daytime in-center hemodialysis at two locations, home peritoneal dialysis and short-daily home hemodialysis programs and cares for about 270 patients. Vanderbilt also offers a comprehensive renal transplant program.
Patients can call Vanderbilt East at 467-4070 if they are interested in learning more about the nocturnal in-center hemodialysis program.