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What is in-center nocturnal dialysis?

In-center nocturnal dialysis is hemodialysis done in a dialysis center during the night while patients with chronic kidney disease (CKD) sleep. Generally, people on in-center nocturnal dialysis arrive at the dialysis center in the evening and receive approximately eight hours of dialysis treatment. They sleep at the clinic three nights a week while they dialyze on the dialysis machine. They are able to bring their dinner, watch television, read a book, listen to music, chat with their health care staff and each other or any other activity they can do at dialysis. Eventually, lights are dimmed at an appropriate time so patients can get some sleep. When this happens, everyone in the center knows that nocturnal dialysis patients need some quiet time and are thoughtful of when others need to rest.

Many people with CKD who choose nocturnal dialysis report having a better quality of life. This may be partly due to the physical improvements these patients generally report seeing in their daily lives. Many patients say they feel much better and find they have a much better appetite after beginning nocturnal dialysis. Nocturnal hemodialysis patients generally have a higher Kt/V (adequacy of dialysis) indicating their blood is cleaner. For patients who perform nocturnal dialysis at home five to six nights per week, there appears to be less of a problem with anemia and blood pressure is often found to be easier to control, which has been attributed to longer dialysis sessions.

Nutrition considerations for people on in-center nocturnal dialysis

Because in-center nocturnal dialysis treatments are longer than traditional hemodialysis treatments, people on in-center nocturnal dialysis may have different nutritional needs than people on traditional hemodialysis.

The majority of special nutrition considerations for chronic kidney disease patients on in-center nocturnal dialysis stem from the improved albumin levels that many people experience. Albumin is the most common protein found in the blood and is responsible for measuring adequate nutrition in a person’s body. Albumin in your blood helps remove fluid during dialysis and pulls extra fluid from swollen tissues back into the blood where it is removed by a dialyzer. When blood is cleaned out like this and toxins are removed, food can taste a lot better to patients on dialysis. Improved albumin levels usually occur due to improved appetites for many people. Having the desire to eat more may mean weight changes and/or problems with phosphorus control. So, while an improved appetite is often a good thing, patients on in-center nocturnal dialysis should work closely with their renal dietitians to ensure they remain at a healthy weight and keep their phosphorus levels under control.

Main components of the in-center nocturnal dialysis diet

Although everyone is unique and dialysis diets vary, there are some main components that most dialysis patients should consider.

• Protein

Protein intake is important for dialysis patients to keep their albumin levels up. Albumin is a protein that helps the body stay healthy, and it’s used as a measure of nutrition for dialysis patients. People on in-center nocturnal dialysis generally have healthy albumin levels and less difficulty maintaining normal albumin. Your dietitian will work with you to determine how much protein you need.

• Sodium

High sodium intake can cause thirst and fluid retention. The result of this may be shortness of breath and congestive heart failure. In addition, dialysis treatments for patients with too much fluid retention can be difficult due to drops in blood pressure and cramping as the extra fluid is removed. Yet those who choose the in-center nocturnal dialysis can be gentler, because fluid is removed more slowly with little chance of a dialysis patient feeling exhausted after treatment.

People on in-center nocturnal dialysis may be able to have more sodium than people on traditional hemodialysis. Your renal dietitian will consider your residual kidney function and any other conditions such as water gain between treatments, signs of water retention, hypertension and cardiovascular disease when determining how much sodium you should have.

• Fluid

Because people on in-center nocturnal dialysis have longer treatment periods, they may be able to have more fluid than people on traditional hemodialysis. Your nurse and dietitian will work with you to determine how much fluid is safe for you to consume on a daily basis. They will let you know the amount of water weight you should gain between dialysis treatments.

• Calories

When you are at a healthy weight, you often feel your best. That’s why it’s important to get the right amount of calories to maintain a healthy weight. People on nocturnal dialysis generally have healthier appetites than in-center hemodialysis patients and, therefore, more frequently meet daily calorie requirements. In fact, some may have such a healthy appetite that it causes them to eat more calories than their bodies need. As a result, they may gain extra body fat, which can be unhealthy. These patients must still work to eat a healthy diet, avoid over eating and include exercise to maintain a healthy body weight.

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High levels of potassium can be life threatening for dialysis patients. Therefore, it’s important for all dialysis patients to follow their dietitian’s guidelines for potassium consumption. Nocturnal dialysis patients may not have to limit potassium as much as someone on traditional hemodialysis. Lab results for potassium will determine how liberal the diet can be with nocturnal dialysis.

• Phosphorus

Phosphorus is one of the biggest dietary challenges most dialysis patients face because dialysis does not remove large amounts of phosphorus. Medicines called phosphorus binders must be taken with food to bind phosphorus that dialysis cannot remove. Phosphorus binders are prescribed by your doctor and you should take it as instructed. A low phosphorus diet is 800 to 1,000 mg. People on in-center nocturnal dialysis will generally be advised to limit foods containing the most phosphorus. For some people phosphorus control is easier on nocturnal dialysis. The number of phosphorus binders may be reduced.

• Renal vitamins

Water soluble vitamins are lost from the blood during the dialysis treatment. It’s important to continue taking a renal vitamin each day, after dialysis on treatment days.

Working with a renal dietitian

Renal dietitians specialize in the kidney diet and help people with end stage renal disease (ESRD) get the nutrition they need to feel their best. In-center nocturnal dialysis patients usually meet with their renal dietitian within 30 days of starting their nocturnal program. Follow-up meetings generally occur once a month with the renal dietitian to go over your blood work and any modifications necessary to help improve your nutrition. Personalized diet counseling, lab reviews and suggestions on ways to improve each patient’s outcomes are also provided. The renal dietitian will also schedule at least one annual meeting in addition to monthly follow-up meetings in order to review the nutritional status and progress of the patients. Again, this is to help you begin and maintain a healthy, kidney-friendly diet.

Summary

Diets for those chronic kidney disease patients who dialyze more frequently or for longer periods of time – such as in-center nocturnal dialysis – generally have fewer restrictions than the in-center dialysis diet. It’s important to listen to your health care team, especially your renal dietitian, and follow the dietary guidelines they set to keep your healthy. If your renal diet is effective, you should feel better, have a healthier appetite, achieve good blood pressure control and experience less swelling.