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Blood Purif. 2019 Nov 13:1-8. doi: 10.1159/000503679. [Epub ahead of print]

Nocturnal Hemodialysis Compared with Conventional Dialysis for End-Stage Renal Disease Treatment in Polycystic Kidney Disease Patients.

Author information

1
Division of Nephrology, Kidney Institute, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
2
Department of Gastroenterology and Hepatology, Jinling Hospital, Nanjing, China.
3
Department of Health Statistics, Second Military Medical University, Shanghai, China.
4
Department of Nephrology, Zhabei Central Hospital of Jing'an District, Shanghai, China.
5
Division of Nephrology, Kidney Institute, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China, shengqiang.yu@smmu.edu.cn.

Abstract

BACKGROUND:

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary cause of end-stage renal disease (ESRD). Little is known about outcomes after in-center nocturnal hemodialysis (NHD) treatment in ADPKD patients with ESRD.

OBJECTIVES:

This study aimed to evaluate the effects of in-center NHD compared with conventional hemodialysis (CHD) and peritoneal dialysis (PD) in ADPKD.

METHODS:

We used data of ADPKD adult patients with ESRD in the hospital database from 2000 to 2016. Propensity score matching, competing-risk regression, and Cox regression models were used for analysis.

RESULTS:

A total of 170 ADPKD patients were included. The median follow-up time was 5.5 years. In the overall multivariate-adjusted analysis, no significant difference of mortality risk was found in NHD vs. CHD (hazard ratio [HR] 1.33, 95% CI 0.26-6.73, p = 0.31) and PD (HR 1.06, 95% CI 0.14-7.71, p = 0.55), respectively. The overall survival rate also was not significantly different among the 3 groups (p = 0.88). Based on the propensity score, 26 patients on CHD and 26 patients on PD were successfully matched to 13 NHD patients. In the matched analysis, NHD was not associated with a lower risk of mortality compared with CHD (HR 2.14, 95% CI 0.33-14.00, p = 0.31) and PD (HR 0.68, 95% CI 0.52-8.94, p = 0.55). The result was similar when treating renal transplantation as a competing event. However, NHD was associated with a lower rate of complications (38.5 vs. 84.6%, p = 0.003) and a higher level of serum albumin (p < 0.001) compared with PD.

CONCLUSIONS:

NHD may not be a better choice in survival compared with conventional dialysis modalities for ADPKD patients in this pilot study. Patients in NHD have fewer complications than PD. Future studies with large sample sizes and longer follow-up are required.

KEYWORDS:

Dialysis; Hemodialysis; Mortality; Peritoneal dialysis; Polycystic kidney disease

PMID:
31722330
DOI:
10.1159/000503679

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