Three nights a week 55-year-old dialysis patient Kathy Denamy arrives at Vancouver General Hospital with her pyjamas, ready for a full night of dialysis while she sleeps.

Denamy, who works as a bookkeeper in Surrey during the day, is a participant in the BC Renal Agency-supported nocturnal hemodialysis pilot program. Believed to be the first of its kind in North America, this innovative program is for patients trained to manage their own dialysis, but who are unable to accommodate the equipment and supplies required for dialysing at home.

Using hospital dialysis machines that would normally sit idle through the night, patients in the program are able to dialyse for eight hours while they sleep. This is double the dialysis time provided to patients at dialysis clinics during normal daytime hours.

“Before, I was dialyzing three times a week during days and after four and a half hours of dialysis I’d find I was really tired,” says Denamy, who was forced to reduce her hours of work because she needed more rest in the afternoons.

“I’m a single person so I need to work to support myself,” says Denamy. “When I started doing nocturnal dialysis I found I had more energy and I could last the whole day.” As a result, she is now back to working full-time hours at her job.

“We’ve created a situation where patients can take ownership of their treatment and double the amount of dialysis they receive compared to conventional treatment,” says Dr. Michael Copland, head of independent hemodialysis for the BC Renal Agency.

According to Copland, longer dialysis treatments are associated with better health outcomes and improved quality of life for kidney patients.

In addition to patient benefits, the nocturnal program offers significant cost savings from the minimal staffing required for patients managing their own dialysis. With just one nurse on duty six self-managing dialysis patients, the annual cost of care is $36,000 per patient. By comparison, with a ratio of one nurse for every three patients, the average per patient cost for conventional dialysis is $60,000 a year.

Research into the longer-term effectiveness of the nocturnal dialysis program involves ongoing tracking of patient outcomes and analysis of health system impacts. The results of this work could provide a foundation for future expansion of the program to other centres around the province.

Dr. Michael Copland is a nephrologist and medical director of the BC Renal Agency’s independent hemodialysis program.

Funding sources:
BC Provincial Renal Agency
Vancouver Coastal Health Authority