• Birgit C P Koch, E Christiaan Hagen, J Elsbeth Nagtegaal, Jan B S Boringa, Gerard A Kerkhof, and Piet M Ter Wee.
• Department of Clinical Pharmacy, Meander Medical Center, Amersfoort, The Netherlands. bcp.koch@meandermc.nl
• Am. J. Kidney Dis. 2009 Apr 1; 53 (4): 658-64.

BackgroundEnd-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 DesignA nonrandomized uncontrolled trial. Patients served as their own controls.Setting & ParticipantsThirteen 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.InterventionsSix months of treatment with nocturnal in-center dialysis 4 nights/wk with 8-hour sessions.Outcomes & MeasurementsAt 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.ResultsAfter 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.LimitationsSmall sample size and a nonrandomized uncontrolled study design.ConclusionsPatients after 6 months of in-center nocturnal hemodialysis had significant improvements in subjective and objective sleep parameters and partially restored nocturnal melatonin rhythm.

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