Emory
Researchers Report Elderly Kidney Disease Patients Who Undergo Dialysis
in the Morning Live Longer Than Those Treated in Afternoon
Elderly patients
with renal failure, who undergo dialysis treatment in the morning, live
more than a year longer than patients who receive treatment in the afternoon,
according to a group of Emory University researchers. The findings were
published in the December 5 issue of the Journal of the American Medical
Association (JAMA).
According to the National
Kidney Foundation of Georgia, end-stage renal disease (ESRD), more commonly
called kidney failure, is an epidemic in the state of Georgia. Georgians
with ESRD lose their kidney function at the second highest rate in the
United States. The most common causes of kidney disease in Georgia are
uncontrolled high blood pressure (38%) and complications from poorly
managed diabetes (35%).
Therefore, Donald Bliwise,
Ph.D., associate professor of neurology, Emory University School of
Medicine, and colleagues decided to investigate the connection between
the survival of patients with ESRD and the time of day those patients
received dialysis.
"To our knowledge, this is
the first time an association between renal failure and time of day
treatment has been studied," says Dr. Bliwise. "We believe determining
the time of day patients received hemodialysis (HD) is an important,
yet frequently overlooked, factor in survival." Most ESRD patients receive
hemodialysis (the process to remove toxic wastes from the blood of patients
with renal failure) throughout the course of their illness, customarily
in the morning or afternoon. The time of treatment is generally based
on space availability at a dialysis center or the patient's preference.
The Emory researchers followed
242 patients, ages 60 and older, for 11 years or until those patients
died. The patients underwent treatment at 58 dialysis centers across
the state of Georgia. Of those patients, 167 were seen during the morning
shift and 75 were seen during the afternoon shift. Morning dialysis
treatment began between 6 and 11 a.m. Afternoon dialysis treatment began
between 11:30 a.m. and 4 p.m.
"Patients who received dialysis
during the morning shift survived, on average, for 941 days after entering
the study compared to 470 days for patients receiving dialysis during
the afternoon shift," says Kathy Parker, Ph.D., R.N., associate professor
of nursing, Nell Hodgson Woodruff School of Nursing, Emory University
School of Medicine. Dr. Parker is a co-author on the paper, along with
Nancy Kutner, Ph.D., professor of rehabilitation medicine, Emory University
School of Medicine.
A sleep and aging expert,
Dr. Bliwise says the study showed a connection between extra sleep in
the morning, during dialysis treatment, and prolonged life of these
patients. "In the case of the elderly HD patients, they may simply have
found it easier to sleep during the morning shift because they arose
as early as 5 a.m. to travel to their dialysis center," says Dr. Bliwise.
Previous animal and human studies have shown that sleep is vital for
good health, and lack of sleep can cause diseases, such as renal failure,
to worsen.
A chronobiologic basis (that
is, the effect of time on living systems) for medical disease and/or
its treatment has long been recognized. "Chemotherapies for cancer
have been reported to have differential effects depending on the time
of day when they are administered," Dr. Bliwise adds. "Diseases
such as heart attacks and stroke are known to have a greater tendency
to occur at certain times of the day. Even symptoms such as headaches
and chronic pain often vary during the day. So understanding how other
medical diseases, such as renal failure, can be treated over the 24-hour
day may carry great practical importance."
The team's multidisciplinary
research work was supported jointly by grants from the National Institutes
of Health.
The authors point out that
their data, indicating apparently positive effects of morning dialysis,
were seen in a group of elderly patients. But it is unclear whether
patients younger than age 60 would have the same benefits. Randomized
clinical trials may be needed to determine the effectiveness of morning
dialysis treatments for any age group.
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