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Effects of nocturnal hemodialysis on melatonin rhythm and sleep-wake behavior: an uncontrolled trial.
Am J Kidney Dis. 2009 Apr; 53(4):658-64.AJ

Abstract

BACKGROUND

End-stage renal disease and its treatment are associated with sleep disturbances such as deterioration of the circadian sleep-wake pattern. Melatonin rhythm, which has an important role in this pattern, is disturbed. The nocturnal melatonin surge is absent in this population. Whether nocturnal in-center hemodialysis changes melatonin and sleep-wake rhythms is unknown.

STUDY DESIGN

A nonrandomized uncontrolled trial. Patients served as their own controls.

SETTING & PARTICIPANTS

Thirteen daytime hemodialysis patients (median age, 58 years; 5 women) from our hospital receiving conventional daytime hemodialysis 3 times weekly for 3 to 4 hours each session.

INTERVENTIONS

Six months of treatment with nocturnal in-center dialysis 4 nights/wk with 8-hour sessions.

OUTCOMES & MEASUREMENTS

At baseline, while still on conventional hemodialysis therapy, polysomnography was performed, sleep questionnaires were filled out, and melatonin concentration in saliva was obtained. After 6 months of in-center nocturnal hemodialysis, all measurements were repeated.

RESULTS

After 6 months of in-center nocturnal hemodialysis, polysomnography showed significant improvements in sleep efficiency (P = 0.05) and stage 3/4 sleep (P = 0.03) in comparison to t = 0. Trends in improvement of rapid-eye-movement sleep, awake time, and oxygen saturation were seen after 6 months of in-center nocturnal hemodialysis therapy. Sleep questionnaires showed a trend in improved sleep quality and daytime function. Patients were less exhausted during the daytime. The nocturnal melatonin surge was partially restored.

LIMITATIONS

Small sample size and a nonrandomized uncontrolled study design.

CONCLUSIONS

Patients after 6 months of in-center nocturnal hemodialysis had significant improvements in subjective and objective sleep parameters and partially restored nocturnal melatonin rhythm.

Authors+Show Affiliations

Department of Clinical Pharmacy, Meander Medical Center, Amersfoort, The Netherlands. bcp.koch@meandermc.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18950916

Citation

Koch, Birgit C P., et al. "Effects of Nocturnal Hemodialysis On Melatonin Rhythm and Sleep-wake Behavior: an Uncontrolled Trial." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 53, no. 4, 2009, pp. 658-64.
Koch BC, Hagen EC, Nagtegaal JE, et al. Effects of nocturnal hemodialysis on melatonin rhythm and sleep-wake behavior: an uncontrolled trial. Am J Kidney Dis. 2009;53(4):658-64.
Koch, B. C., Hagen, E. C., Nagtegaal, J. E., Boringa, J. B., Kerkhof, G. A., & Ter Wee, P. M. (2009). Effects of nocturnal hemodialysis on melatonin rhythm and sleep-wake behavior: an uncontrolled trial. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 53(4), 658-64. https://doi.org/10.1053/j.ajkd.2008.08.006
Koch BC, et al. Effects of Nocturnal Hemodialysis On Melatonin Rhythm and Sleep-wake Behavior: an Uncontrolled Trial. Am J Kidney Dis. 2009;53(4):658-64. PubMed PMID: 18950916.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of nocturnal hemodialysis on melatonin rhythm and sleep-wake behavior: an uncontrolled trial. AU - Koch,Birgit C P, AU - Hagen,E Christiaan, AU - Nagtegaal,J Elsbeth, AU - Boringa,Jan B S, AU - Kerkhof,Gerard A, AU - Ter Wee,Piet M, Y1 - 2008/10/31/ PY - 2008/04/15/received PY - 2008/08/01/accepted PY - 2008/10/28/pubmed PY - 2009/4/10/medline PY - 2008/10/28/entrez SP - 658 EP - 64 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 53 IS - 4 N2 - BACKGROUND: End-stage renal disease and its treatment are associated with sleep disturbances such as deterioration of the circadian sleep-wake pattern. Melatonin rhythm, which has an important role in this pattern, is disturbed. The nocturnal melatonin surge is absent in this population. Whether nocturnal in-center hemodialysis changes melatonin and sleep-wake rhythms is unknown. STUDY DESIGN: A nonrandomized uncontrolled trial. Patients served as their own controls. SETTING & PARTICIPANTS: Thirteen daytime hemodialysis patients (median age, 58 years; 5 women) from our hospital receiving conventional daytime hemodialysis 3 times weekly for 3 to 4 hours each session. INTERVENTIONS: Six months of treatment with nocturnal in-center dialysis 4 nights/wk with 8-hour sessions. OUTCOMES & MEASUREMENTS: At baseline, while still on conventional hemodialysis therapy, polysomnography was performed, sleep questionnaires were filled out, and melatonin concentration in saliva was obtained. After 6 months of in-center nocturnal hemodialysis, all measurements were repeated. RESULTS: After 6 months of in-center nocturnal hemodialysis, polysomnography showed significant improvements in sleep efficiency (P = 0.05) and stage 3/4 sleep (P = 0.03) in comparison to t = 0. Trends in improvement of rapid-eye-movement sleep, awake time, and oxygen saturation were seen after 6 months of in-center nocturnal hemodialysis therapy. Sleep questionnaires showed a trend in improved sleep quality and daytime function. Patients were less exhausted during the daytime. The nocturnal melatonin surge was partially restored. LIMITATIONS: Small sample size and a nonrandomized uncontrolled study design. CONCLUSIONS: Patients after 6 months of in-center nocturnal hemodialysis had significant improvements in subjective and objective sleep parameters and partially restored nocturnal melatonin rhythm. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/18950916/full_citation/Effects_of_Nocturnal_Hemodialysis_on_Melatonin_Rhythm_and_Sleep_Wake_Behavior:_An_Uncontrolled_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(08)01244-4 DB - PRIME DP - Unbound Medicine ER -