BENEFITS OF ‘NHHD’/’SHD’
1. Nocturnal Home Hemodialysis (NHHD) 5-6 sessions per week, for 6-8 hours is an option to be considered when the patient is not showing adequate improvement in clinical and biochemical parameters, indicating ‘dialysis inadequacy’.
2. Reduction in cardiovascular related hospitalisations has been documented with Nocturnal Home Hemodialysis.
3. Studies have shown
- left ventricular mass progression reduction
- better control of hypertension
- anemia with reduction in the requirements of erythropoietin dosage
- achievement of ‘near normal’ sodium, potassium, serum phosphate, serum albumin levels, beta-2-microglobulins clearance etc.
All these cumulative benefits are feasible with daily Nocturnal Hemodialysis whether done in the hospital centre or in the patient’s own home. In a particular renal unit in France, none of their patients need Antihypertensive Medications due to the achievement of good ‘BP’ control due to ‘HD’ hours being done per week. In Dialysis Centres, where HD hours are of more duration or in frequency, Serum sodium, potassium, parathyroid hormone level, pre-dialysis blood urea nitrogen levels are very much near the normal range, explaining the patient’s better physical health status. Oxidative stress and inflammation markers are also reduced by NHHD/Daily SHD.
4. The choice of Nocturnal Home Hemodialysis is not just for convenience of the patient but enables the patient to receive better dialysis results. Nutritional parameters improve, with better appetite, and increased energy level, and ability to undertake good exercise program with increased exercise tolerance has been documented. Reduction in serum phosphate to normal level prevents progression of kidney related Mineral-Bone-Disease.
5. Favourable results have been observed with cardiovascular benefits in Nocturnal Home Hemodialysis. It is expected the same benefit will flow through for those on Short Hemodialysis of 3-4 hours 5-6 times a week.
6. Sleeping during Hemodialysis can be observed in conventional thrice weekly dialysis centre, and is a clue for possible dialysis insufficiency. Nocturnal Home Hemodialysis reduces Sleep Apnea and other sleep related problems including Insomnia, Daytime Sleepiness, Periodic Limb Movements, Restless Leg Syndrome, after the initiation of Nocturnal Home Hemodialysis. The same benefits can be expected if Nocturnal Slow Home Hemodialysis can be provided in a hospital-based-centre, but is not generally available.
7. ‘Recovery time’ after the 4-5 hour ‘HD’ session in thrice weekly Hemodialysis is prolonged and can last for 2 hours or more. ‘Recovery time’ is definitely of lesser duration, and can be as brief as half an hour in Nocturnal Hemodialysis Program as well as in ‘Frequent Hemodialysis’ wherever it is done, whether in hospital or in patient’s home as ‘Daily SHD’..
8. Incidence of Intradialytic Hypotension is reduced, due to better dialysis adequacy.
9. When the Hemodialysis (NHD/FHD) related benefits are obvious and become stabilised, the duration of individual sessions can be reduced.
10. Home Hemodialysis is also cost-effective, when the total related costs are analysed over few years.
11. Based on the documented benefits, decreasing order of importance are:
a. 5-6 times a week as Nocturnal Slow Long Hemodialsis lasting for 6-8 hours with patient sleeping during the Hemodialysis procedure,
b. 5-6 times a week Short Hemodialysis lasting for 3-4 hours with greater options of choosing the time, duration etc when done in the patients’ home.
c. Frequency can be reduced to 3.5 times per week, in selected cases, with ‘HD’ being done for 5 hours on alternate days.
12. The prevalence rate of Home Hemodialysis varies and is not uniform Globally. In descending order, the provision of Home Hemodialysis is led by New Zealand, and Australia. Other countries where Home Hemodialysis concept is spreading are Canada, Finland, The Netherlands, Scotland, USA etc. In future years, further rise can be expected in all Countries.
Introduction of Home Hemodialysis facility has many challenges but it is still worth the trouble. Once the scheme gets established even with a small number of patients initially, even in country like India, in few years, it will become more popular and will reduce the load on the hospital dialysis units.