Nighttime dialysis improves lives of some kidney patients

For nearly four years, Patty Yeager’s life consisted primarily of three things: dialysis, sleep and TV.

Like thousands of others with kidney failure, the 57-year-old woman spent about three hours a day, three days a week on a machine having her blood filtered. When she wasn’t at the dialysis center, she was too tired to do anything but nap or sit.

That changed in March when Yeager signed up for a new way of getting dialysis that removed the drudgery and, more importantly, the crippling exhaustion from her routine. Simple as it may sound, that was dialyzing at night.

Yeager still shows up at DaVita’s Printers Place Dialysis Center three times a week, only now she undergoes dialysis that lasts eight hours instead of three, and she’s able to sleep during it.

The benefits are two-fold: Her waking hours no longer revolve around dialysis, and the extra time spent on the machine has been shown to remove more poisons from the blood and reduce side effects such as fatigue.

”I don’t even feel like I’ve been at dialysis,” Yeager said about waking up from her overnight sessions. “I don’t feel like a Mack truck hit me.”

The thinking behind nocturnal dialysis is that more time on dialysis closer replicates natural kidney function, which works around the clock to cleanse the blood and keep fluids in check. Dialysis patients only get that effect for the few hours they spend with each session on the machine. This rapid filtration is taxing on the body and isn’t as efficient.

The concept emerged in Europe, said Dr. Allen Nissenson, chief medical officer of DaVita. The company, one of the country’s largest dialysis providers, began offering elsewhere it a few years ago and made it available in Colorado Springs in March, the only center in Colorado Springs to do so.

Nocturnal dialysis is more expensive than daytime dialysis, but DaVita declined to provide those costs. Medicare pays the same for each; most dialysis patients are on Medicare.

There’s no research to show whether nocturnal dialysis equates to a longer life expectancy, but some studies have found that it improves blood pressure and the mineral content of the blood, compared with traditional daytime dialysis. But many doctors feel its just a matter of time before more health benefits are scientifically proven.

“The expectation is that this approach should have a significant impact on hospitalizations,” said Nissenson. Better blood-pressure, less fluid retention, and improved blood quality will likely lead to fewer visits to the emergency room, he said.

For Yeager, it’s not what’s in the medical journals that keeps her coming back each night. It’s being able to play with her nine grandchildren and mow her yard. Such anecdotes are typical among noctural dialysis patients.

“They almost universally say that ‘I feel better,’” said Dr. Jesse Flaxenburg, a Colorado Springs nephrologist at Pikes Peak Nephrology Associates.

Despite its benefits, nocturnal dialysis is not for everyone. Some people can’t sleep through the night at a dialysis center. And DaVita puts only its most medically stable patients on the nighttime program, because nurses have a more hands-off approach at night to avoid disturbing people as they sleep, Nissenson said. Other people prefer to stick with daytime dialysis because they can socialize with other patients and talk to nurses.

Yeager is one of nine nocturnal patients out of several hundred people with end-stage renal disease in the region. Nationwide, DaVita has about 1,000 nocturnal dialysis patients compared with about 113,000 on other forms of dialysis.

Nocturnal dialysis is among several new options that have emerged in recent years but kidney doctors say a transplanted kidney remains the best solution for people with end-stage renal disease.

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