Nocturnal dialysis


These days it seems Arlene Ejercito isn’t short of energy. In fact, she has no complaints.

Unlike many dialysis patients who struggle with fatigue and low energy, the 35-year-old patient’s day is jam packed with activities. After a full day at the office where she works as a compliance officer for a major mutual funds company, Ejercito can be found running up to eight kilometers, four times a week, or visiting St. Michael’s Hospital for nocturnal dialysis.

One of 24 patients who are part of the intermittent in-center nocturnal hemodialysis program launched at the hospital in March 2004, Ejercito, like others, is lauding the benefits of the novel program.

“Nocturnal dialysis helps me tremendously because I work in a fast-paced environment,” she explained. “Having to go (to dialysis) at night for eight hours, I feel rested and feel great the next day.”

The first extensive review of the program, believed to be the only one in Canada and one of few in North America, wrapped up recently and the feedback from patients is overwhelmingly positive.

“I tried it, I liked it and I stayed,” program patient Tiberio Medeiros said.

The first patient on the program, Medeiros says he feels better than ever.”I have more energy, I feel better and I have more freedom,” he said.

Patients on the program receive dialysis for seven to eight hours, in hospital, three nights per week under the watch of specially-trained nurses. Traditionally, hemodialysis is provided to patients for four hours, three times each week.

Research has shown home nocturnal hemodialysis, given five to seven nights per week, is effective in improving blood pressure, reducing phosphate levels which can cause bone disease, improving hyperparathyroidism and stabilizing vascular calcification.

“Patients who participated in the nocturnal hemodialysis program are seeing significant improvements in overall quality of life and biochemical disturbances,” said medical director of the Diabetes Comprehensive Care Program and originator of the program at St. Michael’s Hospital, Dr. Marc Goldstein. “Patients are reporting better appetites, energy levels and sleep patterns.”

In fact, according to Alison Thomas, clinical nurse specialist/nurse practitioner in the hospital’s hemodialysis unit, the percentage of urea reduction, a marker for the quality of dialysis treatment for patients in the program, is up to nearly 90 per cent compared to 65 to 75 per cent for those on traditional methods.

“Patients are seeing significant differences in their clinical condition,” Thomas said. “This program has been a success not only because of the willingness of patients to participate but also of our hardworking staff, especially our nurses who have been challenged to acquire a new set of skills. This is a further testament of our staff’s commitment to quality of care and compassion to our patients.”

Today, these patients, including Ejercito are reaping the rewards.

While Ejercito says it took a while to get used to sleeping at a hospital overnight, nocturnal dialysis has been more convenient for her than traditional methods.

“You go in, you go to sleep and once you wake up, it’s done,” she said. “You don’t have to worry about anything.”