We compared the efficacy and the long-term effects of nocturnal hemodialysis (NHD) versus conventional hemodialysis (CHD) in controlling serum phosphate levels in patients with end-stage renal disease (ESRD). Patients underwent thrice weekly CHD and were subsequently switched to NHD six nights weekly. In the "acute" study serum and dialysate phosphate were measured during and after dialysis, and the total dialysate was collected to calculate mass solute removal. Although pre-dialysis (1.7 +/- 0.6 vs. 1.5 +/- 0.8 mM) serum phosphate levels were similar in CHD and NHD, respectively, post-dialysis levels were slightly lower with CHD (0.7 +/- 0.2 vs. 0.8 +/- 0.2 mM, P < 0.05). The measured phosphate removed per session of CHD or NHD was comparable, 25.3 +/- 7.5 versus 26.9 +/- 9.8 mumol/session, respectively. On the other hand, the cumulative weekly phosphate removal was significantly higher with NHD as compared to CHD, 75.8 +/- 22.5 versus 161.6 +/- 59.0 mumol/week (P < 0.01). In the "chronic" study serum phosphate levels were measured monthly for five months on CHD and for five months after the patients were switched to NHD. Dietary phosphate intake and the dosage of phosphate binders were tabulated. Serum phosphate levels fell during NHD: 2.1 +/- 0.5 mM at the beginning of the study and 1.3 +/- 0.2 mM five months after being switched to NHD (P < 0.001). At the same time dietary phosphate intake increased by 50%. By the fourth month of NHD therapy none of the patients was taking any phosphate binders. In conclusion, NHD is more effective in controlling serum phosphate levels than CHD, allowing patients to discontinue their phosphate binders completely and to ingest a more liberal diet.

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To study the prevalence and pathogenesis of uremic pruritus, CAPD and HD patients were asked to complete a questionnaire. The replies were quantitated based on numerical scales, and the results were compared with various hematological and biochemical parameters, underlying disease, and duration of dialysis. There were 113 CAPD patients (63 males and 50 females), mean age 60 (range 20–84) years, average time on CAPD 20 (range 1–163) months and 76 HD patients (44 males and 32 females) mean age 57 (range 23–81) years, mean time on HD 44 (range 2–242) months. Replies to questions were evaluated and graded by the same Investigator who did not know the patients. Pruritus was present in 70 (62%) CAPD patients (64% in females and 600/0 in males p=NS) and in 41 (54%) HD patients (69% in females and 43% in males, p=0.025). Before starting dialysis pruritus was present in 30% CAPD patients and 28% HD patients. Pruritus was graded as mild, moderate and severe; the distribution was 58.6%, 34.3%, and 7.1% (CAPD) and 43.90/0, 41.5%, and 14.6% (HD), respectively. Dry skin was reported by 73% CAPD patients and 72% HD patients. This xerodermia was correlated with the severity of pruritus and was also present In 65% CAPD and 48.5% HD patients without pruritus. Patients with pruritus were older than those without pruritus both for CAPD (63 vs 54 years, p=0.004) and HD (61 vs 51 years, p=0.003). A significant correlation was observed only between pruritus score and age for CAPD patients. There were no other correlations between pruritus and the other parameters studied. We conclude that pruritus Is a frequent symptom In dialysis patients, but It Is severe only In a small proportion. Its prevalence, as also that of dry skin, Increases after start of dialysis and Is higher In females on HD. Patients with pruritus are older, and the severity of pruritus correlates with age in the CAPD patients. Presence of dry skin correlates with severity of pruritus, and Its prevalence Is high even among patients without pruritus.

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