Nocturnal hemodialysis (NHD) adapted to the in-centre setting--a pilot study

Nocturnal hemodialysis has proven to be an effective and safe modality with many benefits. Using NHD parameters, two in-centre conventional hemodialysis (CHD) patients participated in a three-week in-hospital trial to test the viability of an in-hospital nocturnal hemodialysis (NHD) program. One RN was responsible for the initiation and monitoring of all treatments. In order to objectively measure results, we maintained a daily log detailing alarm situations, response time for both technical and medical support, and required interventions. Patient and staff comments were recorded daily. Miscellaneous problems were also documented. Both patients were given quality of life questionnaires and patient satisfaction surveys pre- and post-trial. Occasionally, difficulties with machine and vascular access problems were encountered. Results revealed that subjectively, both patients felt much better on NHD when compared to CHD, however they found that their personal lives were adversely affected by their absence from home. Upon completion of the trial, the accumulated data was analyzed and recommendations were made. It was decided that a staff/patient ratio of 1:3 would be safe providing that the physical environment allowed the RN to oversee all functions. Due to patient dissatisfaction with treatments six nights per week, it was suggested that flexibility with patient scheduling was essential. However, it was agreed that six nights per week would be advantageous within a chronic care facility offering hemodialysis therapy. To ensure complete medical coverage, renal fellow integration within the nocturnal project was recommended. In conclusion, we feel that the adaptation of NHD to the in-centre setting is viable with the appropriate patient population and physical environment.