March 24, 2014
Story by Greg Harris; Photo by Paul Rotzinger
For Caitlin Tighe, undergoing eight-hour dialysis overnight at the Foothills Medical Centre in Calgary has meant she feels well enough in the morning to go for a swim.
For Alan Clarke, nighttime dialysis has helped improve his health to the point where the number of medications he takes has been reduced from 12 to one.
The two are among 26 patients taking part in a new overnight program in Calgary that offers dialysis over eight hours, which is much gentler on the body than four-hour daytime dialysis, the current standard of clinical care here and around the world.
“Patients enjoy a much better quality of life with nocturnal hemodialysis,” says Dr. Jennifer MacRae, Medical Director of Hemodialysis and Home Hemodialysis for the Southern Alberta Renal Program. “They tolerate it better, and have more energy and fewer health complications.”
Although overnight home hemodialysis has been available in Alberta for many years, it requires patients to undergo training and be able to accommodate necessary renovations to their living quarters. Not all patients can meet those requirements.
Patients in the overnight program, which started last October, attend Unit 27 at Foothills three nights a week from about 9 p.m. to 6 a.m., either on a Monday-Wednesday-Friday schedule or a Tuesday-Thursday-Saturday schedule.
Tighe, 30, says she feels like the overnight program has given her her life back.
“Before, when I was doing four hours during the day, I’d be so wiped out afterwards that I’d have to go home and sleep for another four hours. And then, not long after that, it would be time for bed,” says Tighe.
“But now it’s kind of like I don’t even experience dialysis. I arrive there, I get put on the machine, I go to bed and I wake up and it’s over. And I feel so much better.”
Clarke, 60, also experienced improvements after he joined the nocturnal program.
“I no longer have the muscle cramps or headaches I did with the four-hour regimen, and I feel a lot stronger,” he says. “This new program has been like night and day for me. My lifestyle has changed for the better.”
Dialysis is the process of cleansing the blood of toxins and excess fluid when normal kidney function is reduced. A patient’s blood is filtered through a dialyzer and then returned to the body.
In the 1960s, when hemodialysis first began to be widely used, the standard length of treatment was eight hours. With improvements in technology and a desire to lessen the time patients spend on dialysis, the time gradually decreased to the standard four-hour treatment period now in use.
Today, the benefits of a slower-paced cleanse are well established. It’s easier on the heart, produces fewer adverse symptoms like cramping, can lead to improvements in blood pressure, and it allows patients to enjoy a less restrictive diet that includes high-phosphate foods such as nuts, bananas and cheese.
A growing number of centres are starting in-service overnight programs. The University of Alberta Hospital in Edmonton offers a six-bed nighttime program in which patients come in at 11 p.m. and then spend five or six hour on dialysis.
In late 2012, Dr. MacRae spent a sabbatical at Vancouver’s St. Paul’s Hospital to learn how its overnight program was set up, then returned to Calgary to see if a similar program could work here.
“From an administrative point of view, everyone really rallied around the idea,” says Carol Easton, Executive Director of the Southern Alberta Renal Program & Southern Alberta Transplant Program. “We’ve always recognized there was a need for a program like this for our sickest patients that offered a more gentle withdrawal of toxins.”
The overnight program actually requires fewer staffing resources to operate than the daytime programs. During a daytime four-hour dialysis session, one nurse can oversee three patients, whereas at night one nurse can safely take care of five.
In southern Alberta (south of Red Deer), there are about 725 patients on hemodialysis in clinical units. Another 80 are on home hemodialysis and about 228 patients on home peritoneal dialysis.