The London, Ontario, Daily/Nocturnal Hemodialysis Study.

The London Daily/Nocturnal Hemodialysis Study, a prospective, comparative, nonrandomized study, directly compared outcomes of quotidian (daily) hemodialysis patients with conventional thrice-weekly hemodialysis patients. Patients were assigned to either daily (short-hours) hemodialysis (n = 11) or nocturnal hemodialysis (n = 12) and followed up for 5-36 months; all data were directly compared with matched control patients receiving conventional hemodialysis (n = 22). Outcomes evaluated were adequacy (urea kinetics), nutrition, anemia management, blood pressure and volume control, calcium/phosphorus control, and patient quality of life. In addition, a detailed economic analysis was undertaken. The study showed that both quotidian hemodialysis regimens are more effective than conventional hemodialysis in improving weekly urea clearance. Significant clinical improvements were seen with quotidian therapy in the areas of nutrition (short-hours daily), blood pressure (both), volume control (short-hours daily), calcium/phosphorus control (nocturnal), and quality of life (both). A nonsignificant trend for improvement in anemia management was suggested. The economic analysis showed substantial savings in annualized cost per quality-adjusted life-year in changing from conventional hemodialysis (carried out in-center, in satellite units, or at home) to home quotidian hemodialysis. The substantial clinical benefits of home quotidian hemodialysis, combined with the economic advantage shown by this study, clearly justify its expansion. (The details of this study have recently been published in 11 articles in the American Journal of Kidney Diseases[2003;42(suppl 1)].