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[IP] Nightly dialysis better, cheaper -- study

Nightly dialysis better, cheaper -- study
January 11, 2001
Web posted at: 9:19 AM EST (1419 GMT)

BOSTON, Massachusetts (Reuters) -- Overnight blood cleansing for people with 
kidney failure can correct sleep disorders, make patients feel much better 
and, if widely adopted, save millions of dollars a year, a study in Thursday's 
New England Journal of Medicine found.

The findings are part of a broader study of the effects of nocturnal 
hemodialysis, in which patients take dialysis machines home and are trained to 
use them every night, allowing them to run while they're asleep.

"We hope that the sleep study will increase the interest in nocturnal 
hemodialysis," said Dr. Andreas Pierratos of the Humber River Regional 
Hospital in Toronto.

Pierratos told Reuters that about 125 patients are using the technique in the 
U.S. and Canada. In the U.S. 195,000 undergo traditional dialysis, often at 
centers financed by the federal government.

Proponents say nighttime dialysis is like having normal kidneys because all 
the symptoms of kidney failure usually improve or disappear. Patients can 
begin to eat normally again, their itchiness, nausea and tiredness disappear, 
and they can stop taking most of their pills, said Pierratos.

It also saves money, potentially many millions of dollars, the study's author 

"Although nocturnal hemodialysis is slightly more expensive," said Pierratos, 
"we feel that the use of fewer medications and the less frequent 
hospitalizations save a net of about $9,000 per year, per patient."

However the technique is not widely used or accepted because it takes six 
weeks to learn to use the machines, they are expensive and not every dialysis 
patient can be expected to master them.

In addition, federal agencies that pay for dialysis have not embraced the 

Pierratos and Dr. Patrick J. Hanly decided to look at breathing problems 
during sleep because an estimated 50 to 70 percent of dialysis patients suffer 
from sleep apnea, where patients repeatedly stop breathing for short periods 
of time during sleep.

They found that the number of episodes of apnea dropped from an average of 25 
per hour for volunteers receiving conventional dialysis treatments to 8 per 
hour once the patients were switched to overnight dialysis.

Overnight dialysis "corrects sleep apnea" associated with chronic kidney 
failure, the researchers concluded.

At the very least, the new results "are cause to consider adding at least one 
more weekly (dialysis) treatment until a decision can be made" on whether 
overnight dialysis is better than the conventional treatment, said Dr. Eli A. 
Friedman of the State University of New York Health Science Center at 
Brooklyn, in an editorial in the Journal.

The current three-day-a-week schedule that most dialysis patients undergo has 
become the standard at most dialysis centers because it allows workers to 
serve the greatest number of patients at the lowest possible cost, Friedman 
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