The effect of Nocturnal Haemodialysis on Body Composition Karin Ipema, dietician/researcher,

2. The effect of Nocturnal Haemodialysis on Body Composition Karin Ipema, dietician/researcher, Dialysis Center Groningen In cooperation with Hanze University Groningen, Professorship in Health Care and Nursing 1 September 2013

3. Background • 20 -70% Malnutrition and poor physical functioning in dialysis patients • Decline in muscle and fat tissue • Nocturnal HD: • Increase in protein intake • More free time • Improving Quality of life

4. Study Question Is the transition from conventional HD to nocturnal HD after 1 year associated with an increase in fat and/or fat-free mass?

5. Patients • Research group: Nocturnal haemodialysis patients (±4-6 x pw 8 hours dialysis) • Nocturnal In-centre Haemodialysis – every other night 8 hrs dialysis • Nocturnal Home Haemodialysis– 5-6 night pw 8 hrs dialysis • Control group: Conventional Haemodialysis, matched on gender, age, and dialysis vintage (±3 x pw 4 hrs dialysis)

6. Inclusion and exclusion criteria • Inclusion criteria: chronic haemodialysis patients, aged >18 years who were scheduled to start on NHD • Exclusion criteria: short life expectancy (<1 year), a substantial amount of metal in the body, absence of informed consent

7. Method • DEXA-scan Whole body composition • DEXA-scan shortly after the dialysis session CHD Nocturnal HD CHD Conventional HD Dexa 1 Dexa 2

8. DEXA scan

9. Method Study design: • DEXA-scan Whole body composition • DEXA-scan shortly after the dialysis session • Laboratoy measurements: albumin, nPCR, e.g. • Statistical analysis with Linear mixed models

10. Results Patient characteristics: • Recruitment period of 3 years • 21 patients included in the research group, 10 patients did not complete the first year of NHD, : • N=2: difficulty with sleeping • N=7: severe intercurrent sickness (sepsis, hart failure with low blood pressures) • N=1: kidney transplantation

11. Results Nocturnal haemodialysis Conventional haemodialysis N=13 8 male / 5 female Years on dialysis: 3.7 (1-11) DM: 2 persons BMI 25.8 kg/m2 (±3.9) • N=11 - 6 NHHD / 5 NCHD • 6 male / 5 female • Years on dialysis: 4.7 (1-15) • DM: 1 person • BMI 24.7 kg/m2 (±3.7)

12. Results Protein intake & Albumin Effect size interaction: +0.23 g/kg/day (P= 0.027) No significant difference

13. Results Body Composition No significant difference No significant difference No significant difference

14. Results Covariates Co-variates: • Gender • Age • Dialysis vintage Dialyse vintage shows a negative effect on the fat mass, total mass, and BMI: • Fat mass: -1.48 kg per year (P=0,010) • Total mass: -1.65 kg per year (P=0,018) • BMI: -0.6 kg/m2 per year (P=0,011)

15. Conclusion In this study we observed a significant increase in protein intake after the transition from CHD to NHD. One year of nocturnal haemodialysis had no significant effect on body composition in comparison with CHD patients, despite a higher protein intake. In this relatively small study, a longer dialysis vintage had a negative effect on fat mass and BMI. Dialysis vintage seems to have more effect on the body composition than the form of haemodialysis.

16. Questions Tack förattnilyssnade Vi ses i Groningen Karin J.R. Ipema1,2, Ralf Westerhuis1,3, Cees P. van der Schans2,4, Paul E. de Jong3, Wim P. Krijnen2, Riemer H.J.A. Slart5, and Casper F.M. Franssen3 1Dialysis Center Groningen, 2Professorship in Health Care and Nursing – Hanze University Groningen, University of Applied Sciences, 3Department of Internal Medicine, Division of Nephrology,University Medical Center Groningen, 4Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, The Netherlands, 5Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands