Review of clinical outcomes in nocturnal haemodialysis patients after renal transplantation

Abstract

One-year graft outcomes and blood pressures are similar for NHD and CHD patients who undergo renal transplantation. Unlike CHD patients, NHD patients experienced a significant fall in their intra-operative blood pressures, which likely contributed towards the delayed graft function in this cohort of patients. Further prospective studies are needed to examine the underlying differences in haemodynamics and long-term graft survival between the two renal replacement modalities.

Comparison of graft and patient outcomes following kidney transplantation in extended hour and conventional haemodialysis patients

“…These findings contrast with those of two previous small, short‐duration, single‐centre observational studies which examined DGF, defined as post‐transplant dialysis requirement, in nocturnal HD patients . McCormick et al .…”

“…It is plausible that differences in extravascular fluid volume and haemodynamic parameters between extended hour and conventional HD patients could affect allograft function in the early post‐transplant period. Two single‐centre observational studies have examined this effect, by comparing nocturnal and conventional HD patients . Both studies were limited by small patient numbers, short follow‐up duration, and lack of multivariable adjustment for differences in characteristics between the groups.…”

Circadian regulation of renal function

“…Fortunately, chronotherapy has been shown to play a significant role in treating patients on hemodialysis as well. A group of nephrologists from Humber River Regional Hospital and St. Michael's Hospital within the University of Toronto, along with Toronto General Hospital, have provided a wealth of knowledge comparing the effects of nocturnal hemodialysis (NHD) versus conventional hemodialysis (CHD) using patients recruited from these hospitals [206–210]. NHD provides about eight hours of renal replacement therapy while the patient sleeps, 5–7 times a week.…”

Diagnosis and Treatment of Hyper-Delayed Graft Function after Renal Transplantation

“…Based on our experience and review of the literature [6,15,16] , the following measures may reduce the occurrence of ATN in DGF and HDGF patients: (1) careful control of blood pressure before surgery; (2) routine checking of coagulation status after heparin-free hemodialysis, with abnormal coagulation treated by protamine (to neutralize heparin) and moderation of ultrafiltration; (3) cooperation of anesthesiologists and surgeons in the monitoring of infusion speed and volume, with optimal fluid supplement of ϳ 2,000 ml given before opening the blood flow of transplanted kidney; (4) modestly increasing the blood pressure during surgery ( ϳ 20 mm Hg) by administration of a vasopressor before perfusion of the transplanted kidney; (5) early bedside intervention with continuous hemodiafiltration for patients with anuria or oliguria to ensure the safety of the hemodialysis; (6) avoidance of blood pressure fluctuation during hemodialysis that may exacerbate tubule necrosis; and (7) transfer to intermittent hemodialysis after vital signs have stabilized.…”