The effects of nocturnal compared with conventional hemodialysis on mineral metabolism: A randomized-controlled trial

Hemodial Int. 2010 Apr;14(2):174-81. doi: 10.1111/j.1542-4758.2009.00418.x. Epub 2009 Dec 22.


Hyperphosphatemia is common among patients receiving dialysis and is associated with increased mortality. Nocturnal hemodialysis (NHD) is a long, slow dialytic modality that may improve hyperphosphatemia and disorders of mineral metabolism. We performed a randomized-controlled trial of NHD compared with conventional hemodialysis (CvHD); in this paper, we report detailed results of mineral metabolism outcomes. Prevalent patients were randomized to receive NHD 5 to 6 nights per week for 6to 10 hours per night or to continue CvHD thrice weekly for 6 months. Oral phosphate binders and vitamin D analogs were adjusted to maintain phosphate, calcium and parathyroid hormone (PTH) levels within recommended targets. Compared with CvHD patients, patients in the NHD group had a significant decrease in serum phosphate over the course of the study (0.49 mmol/L, 95% confidence interval 0.24-0.74; P=0.002) despite a significant reduction in the use of phosphate binders. Sixty-one percent of patients in the NHD group compared with 20% in the CvHD group had a decline in intact PTH (P=0.003). Nocturnal hemodialysis lowers serum phosphate, calcium-phosphate product and requirement for phosphate binders. The effects of NHD on PTH are variable. The impact of these changes on long-term cardiovascular and bone-related outcomes requires further investigation.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Appointments and Schedules
  • Calcinosis / epidemiology
  • Calcinosis / prevention & control
  • Calcium / blood
  • Calcium Phosphates / blood
  • Circadian Rhythm
  • Combined Modality Therapy
  • Female
  • Hemodialysis, Home / methods*
  • Humans
  • Hyperphosphatemia / blood*
  • Hyperphosphatemia / epidemiology
  • Hyperphosphatemia / prevention & control*
  • Hypertrophy, Left Ventricular / epidemiology
  • Hypertrophy, Left Ventricular / prevention & control
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / metabolism*
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Minerals / metabolism
  • Parathyroid Hormone / metabolism
  • Phosphates / blood
  • Risk Factors


  • Calcium Phosphates
  • Minerals
  • Parathyroid Hormone
  • Phosphates
  • calcium phosphate
  • Calcium