Effects of nocturnal hemodialysis on melatonin rhythm and sleep-wake behavior: an uncontrolled trial

Am J Kidney Dis. 2009 Apr;53(4):658-64. doi: 10.1053/j.ajkd.2008.08.006. Epub 2008 Oct 31.


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.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Circadian Rhythm / physiology*
  • Female
  • Health Surveys
  • Humans
  • Kidney Failure, Chronic / metabolism
  • Kidney Failure, Chronic / physiopathology*
  • Kidney Failure, Chronic / therapy*
  • Male
  • Melatonin / metabolism*
  • Middle Aged
  • Polysomnography
  • Renal Dialysis / methods*
  • Salvia / metabolism
  • Sleep / physiology*
  • Treatment Outcome
  • Wakefulness / physiology*


  • Melatonin