Alternate Night Home Hemodialysis Improves Anemia

Healthy kidneys clean your blood and remove extra fluid in the form of urine. You need dialysis if your kidneys no longer remove enough wastes and fluid from your blood to keep you healthy. Hemodialysis is the most common method used to treat advanced and permanent kidney failure.

Nocturnal home hemodialysis (NHHD) performed on alternate nights improves anemia and decreases the need for an erythropoiesis-stimulating agent (ESA) compared with conventional hemodialysis, according to a new study.

Clara K. Y. Poon, MD, of Princess Margaret Hospital in Hong Kong, and colleagues compared 23 patients receiving NHHD with 25 in-center patients receiving conventional hemodialysis (CHD). In the NHHD group, mean hemoglobin levels increased significantly from 9.37 g/dL at baseline to 11.34 g/dL at 24 months, the investigators reported online ahead of print in Hemodialysis International.

During that same period, the mean weekly ESA requirement decreased significantly from 103.4 U/kg to 47.3 U/kg. In the CHD group, mean hemoglobin levels were 9.5 g/dL at baseline and 9.3 g/dL at 24 months, a non-significant difference. The weekly ESA requirement increased significantly from 89.7 U/kg to 105.9 U/kg. In addition, 26% of the NHHD patients were able to discontinue ESA therapy compared with none of the CHD patients, according to the researchers.

The NHHD group experienced greater increase in standard Kt/V compared with the CHD group.

“NHHD with an alternate night schedule improves anemia and reduces ESA requirement as a result of enhanced uremic clearance,” the authors concluded.

Dr. Poon's team commented that NHHD on alternate nights may be superior to NHHD performed 6 or 7 times a week in terms of anemia management. They cited a cohort study in which investigators examined anemia parameters in patients receiving daily long nocturnal hemodialysis and those undergoing short daily hemodialysis and CHD.

The study, published in the American Journal of Kidney Diseases (2003;42 (S1):S18–S23), found that all patients lost a significant amount of blood in hemodialysis tubing and as a result of laboratory testing compared with baseline, the groups undergoing dailiy hemodialysis experienced a significantly greater amount of blood compared with the CHD group.

“Hence, prolonged and more frequent hemodialysis may increase total blood loss to the blood circuit and it may offset the benefits to anemia by long duration of hemodialysis,” Dr. Poon's team noted.

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How Much Do You Know about Renal Anemia

Then What are the reasons for renal anemia? There are mainly three reasons of renal anemia.

1.The metabolic wastes which stay in the blood circulation can affect the function of platelet and clotting factors, making patients to bleed more easily including bleeding of epistaxis, gingivae, stomach and intestine, which greatly aggravates the anemia.

2.Because of the damage of parenchyma, kidney can not excrete erythrogenin normally, which greatly influences the hematopoietic function of marrow.

3.When the renal function is damaged, the metabolic wastes can not be discharged out of our body normally so they just stay in the blood. These wastes can damage red blood cells directly and shorten the life of red blood cells. Living in such an environment, the red blood cells can not live for a long time. If one gets transfusion, the undamaged renal parenchyma’s function of hematopoiesis can also be greatly affected.

Besides the above, renal anemia also has relation with the early symptom of gastrointestinal tract of renal insufficiency because nausea, vomiting and diarrhoea can make patients malnourished and in turn lead to persistent anemia.

What are the reasons for renal anemia

What are the reasons for renal anemia? There are mainly three reasons of renal anemia.

When the renal function is damaged, the metabolic wastes can not be discharged out of our body normally so they just stay in the blood. These wastes can damage red blood cells directly and shorten the life of red blood cells. Living in such an environment, the red blood cells can not live for a long time. If one gets transfusion, the undamaged renal parenchyma’s function of hematopoiesis can also be greatly affected.

The metabolic wastes which stay in the blood circulation can affect the function of platelet and clotting factors, making patients to bleed more easily including bleeding of epistaxis, gingivae, stomach and intestine, which greatly aggravates the anemia.

Because of the damage of parenchyma, kidney can not excrete erythrogenin normally, which greatly influences the hematopoietic function of marrow.
Besides the above, renal anemia also has relation with the early symptom of gastrointestinal tract of renal insufficiency because nausea, vomiting and diarrhoea can make patients malnourished and in turn lead to persistent anemia.