Effects of Nocturnal Hemodialysis on Melatonin Rhythm and Sleep-Wake Behavior: An Uncontrolled Trial

Koch, Birgit C.P.; Hagen, E. Christiaan; Nagtegaal, J. Elsbeth; Boringa, Jan B.S.; Kerkhof, Gerard A.; Ter Wee, Piet M.

doi:10.1053/j.ajkd.2008.08.006

« Previous Next »American Journal of Kidney Diseases
Volume 53, Issue 4 , Pages 658-664, April 2009

Effects of Nocturnal Hemodialysis on Melatonin Rhythm and Sleep-Wake Behavior: An Uncontrolled Trial

Birgit C.P. Koch, PharmD
- Department of Clinical Pharmacy, Meander Medical Center, Amersfoort, The Netherlands
- Address correspondence to Birgit C.P. Koch, PharmD, Meander Medical Center, Department of Clinical Pharmacy, Postal Box 1502/Utrechtseweg 160, 3800 BM Amersfoort, The Netherlands
E. Christiaan Hagen, MD, PhD
- Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands
J. Elsbeth Nagtegaal, PharmD, PhD
- Department of Clinical Pharmacy, Meander Medical Center, Amersfoort, The Netherlands
Jan B.S. Boringa, MD
- Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands
Gerard A. Kerkhof, PhD
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Center for Sleep Wake Disorders, Medical Center Haaglanden, the Hague, The Netherlands
Piet M. Ter Wee, MD, PhD
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands

Received 15 April 2008; accepted 1 August 2008. published online 28 October 2008.

Background

End-stage renal disease and its treatment are associated with sleep disturbances such as deterioration of the circadian sleep-wake pattern. Melatonin rhythm, which has an important role in this pattern, is disturbed. The nocturnal melatonin surge is absent in this population. Whether nocturnal in-center hemodialysis changes melatonin and sleep-wake rhythms is unknown.

Study Design

A nonrandomized uncontrolled trial. Patients served as their own controls.

Setting & Participants

Thirteen daytime hemodialysis patients (median age, 58 years; 5 women) from our hospital receiving conventional daytime hemodialysis 3 times weekly for 3 to 4 hours each session.

Interventions

Six months of treatment with nocturnal in-center dialysis 4 nights/wk with 8-hour sessions.

Outcomes & Measurements

At baseline, while still on conventional hemodialysis therapy, polysomnography was performed, sleep questionnaires were filled out, and melatonin concentration in saliva was obtained. After 6 months of in-center nocturnal hemodialysis, all measurements were repeated.

Results

After 6 months of in-center nocturnal hemodialysis, polysomnography showed significant improvements in sleep efficiency (P = 0.05) and stage 3/4 sleep (P = 0.03) in comparison to t = 0. Trends in improvement of rapid-eye-movement sleep, awake time, and oxygen saturation were seen after 6 months of in-center nocturnal hemodialysis therapy. Sleep questionnaires showed a trend in improved sleep quality and daytime function. Patients were less exhausted during the daytime. The nocturnal melatonin surge was partially restored.

Limitations

Small sample size and a nonrandomized uncontrolled study design.

Conclusions

Patients after 6 months of in-center nocturnal hemodialysis had significant improvements in subjective and objective sleep parameters and partially restored nocturnal melatonin rhythm.

Index Words: Sleep-wake rhythm, melatonin, nocturnal hemodialysis, polysomnography