Nutritional status in nocturnal hemodialysis

Malnutrition is extremely prevalent in hemodialysis patients and may result in loss of muscle mass and poor physical functioning. Malnutrition is also a major predictor of increased morbidity and mortality. The central theme of this thesis is how the transition from conventional hemodialysis to nocturnal hemodialysis affects nutritional status and body composition. Nocturnal hemodialysis, both at home and in-center, has taken a very prominent place within the hemodialysis modalities. In many Dutch dialysis centers, in-centre nocturnal hemodialysis has become a regular treatment regime. This thesis shows that nutritional intake, especially protein intake, improves following the transition from conventional hemodialysis to nocturnal hemodialysis. Remarkably, we observed no changes in body composition after the transition to nocturnal hemodialysis despite a significantly higher protein intake. Possible causes of these remarkable findings are discussed and advice for additional research is given. However, the findings of this thesis implicate that it is important to consider nocturnal hemodialysis for dialysis patients with suboptimal nutritional status. Patients receiving nocturnal hemodialysis have less or no dietary restrictions with favorable biochemical results compared with conventional hemodialysis.