Nocturnal dialysis pilot project holds promise as life-changer for patients

Three years ago, Jack Cheung’s failing kidneys were destroying his quality of life.

“I couldn’t work for more than two hours at a time,” says the 58-year-old automotive technician. “My hands would cramp, my feet were swollen and I couldn’t stand for more than half an hour.”

He knew what he had to do, but had been holding off until the last possible moment. He’d already been told that dialysis was his best option. However, he dreaded not only the process, but also how his life might be affected by having to attend three four-hour sessions of dialysis at the hospital each week. He didn’t know if he could work around it, and if it would even be worth it.

“I put it off for as long as I could,” he says, “but now I wish I’d done it a lot sooner.”

For Jack, the positive effects of dialysis far outweighed the inconvenience, and he felt better than he had in years.

Overnight advantage

Last year, the Renal Program at St. Paul’s Hospital in Vancouver administered more than 83,000 in-centre dialysis treatments for patients who are physically unable or lack the necessary support system to undertake dialysis at home.

While in-home dialysis is usually performed at night – providing the patient with improved comfort and convenience – hospitals have typically only offered in-centre dialysis during the day, which can pose challenges for patients who must take time away from work and family.

To investigate how to better serve its patients, St. Paul’s launched British Columbia’s first in-centre nocturnal dialysis pilot program in January 2011. The project – a collaborative effort between Providence Health Care, Vancouver Coastal Health and the BC Provincial Renal Agency – requires patients to come to the hospital three times a week, but they do so in the evening and the dialysis is performed overnight as they sleep.

“It’s done more slowly, which is much better tolerated by the body,” says nephrologist Dr. Mercedeh Kiaii, pointing to reduced stress on the heart and other organs. “The longer time also allows the toxins to come out of the cells; during the four-hour daytime therapy we’re only able to remove what’s in the blood.”

The program, which started with 16 participants, is now up to 18 and will almost certainly reach Kiaii’s goal of 20 by the end of the pilot period in January 2012. The program is based on a successful pilot undertaken at St. Michael’s Hospital in Toronto, the first hospital in Canada to offer in-centre nocturnal dialysis.

“We collaborated with the Toronto in-centre program and our own home nocturnal program, and we already had a lot of the infrastructure in place at St. Paul’s, so the pilot project has moved forward very smoothly,” says Kiaii. “We’ve also been fortunate to have a group of dedicated and skilled nurses who have been integral to the program.”

Since entering the program in May, Cheung has not only taken back his days, he’s realized many benefits far beyond his expectations. “With the regular program, I would go right to bed after dialysis. I couldn’t drive long distances and would have to rest three more hours before I could do anything,” he says. “With nocturnal [dialysis], I can work right through the day.”

Cheung says the expanded dialysis has also allowed him to eat more of his favourite foods, like bananas, and drink the occasional beer. It has also reduced his medications significantly – his once daily intake of 20 pills has been cut in half and it’s still dropping.

For patients waiting for a kidney transplant, better dialysis tends to lead to healthier transplant candidates if a suitable kidney becomes available, which will be increasingly important with the incidence of kidney disease currently rising at a rate of 10 per cent a year. Happily, the success of programs like the in-centre nocturnal dialysis pilot project and the support of generous donations from the community will helpSt. Paul’s Hospital continue to be a leader in renal research and patient care.