Despite marked improvements in dialysis technology and emphasis on delivery of an adequate dose of hemodialysis, a majority of the 300,000 patients undergoing conventional thrice-weekly hemodialysis (CHD) have sleep apnea, poor sleep quality, and daytime symptoms of sleepiness and fatigue. Since hemodialysis patients report symptoms of daytime sleepiness and fatigue would strongly influence their choice of dialysis modality and many hemodialysis patients feel impaired by sleepiness and fatigue, it is crucial to characterize how nocturnal hemodialysis will impact sleep. In light of the findings from the MEMO Study which demonstrated no significant quality of life or survival benefit from increased dialysis dose or membrane flux, attention has turned to the potential benefits of nocturnal hemodialysis (NHD). NHD provides the highest dose of dialysis and is more likely to decrease physiologic variations over time compared to any other type of hemodialysis. In small, uncontrolled studies, NHD has been reported to benefit daytime symptoms and reduce sleep apnea. The NI DDK-sponsored Frequent Hemodialysis Network (FHN) is a randomized clinical trial to determine whether NHD (6 times per week) leads to significant improvements in cardiovascular function and physical well-being compared to CHD over a 12-month period. We propose to complement this study with measurements of sleep and fatigue which utilize portable sleep apnea monitors, naturalistic measures of sleep-wake behavior, frequent ecologic sampling methods of sleepiness and fatigue, and centralized telephone surveys of sleep quality in order to gather crucial information of sleep and fatigue while limiting the burden on the parent study. Specifically, we propose to determine the impact of nocturnal hemodialysis on sleep apnea, to evaluate the effect of nocturnal hemodialysis on sleep quality and sleep/wake behaviors, and to assess the benefit of nocturnal hemodialysis on daytime symptoms of sleepiness and fatigue compared to conventional hemodialysis. The proposed study takes advantage of a multi-disciplinary team which offers an exceptional foundation to assess sleep and fatigue among those undergoing hemodialysis in the FHN Trial. This proposal addresses a major public health concern since the CHD population has been shown to have high rates of sleep disorders and reports severe daytime symptoms of sleepiness and fatigue.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
5R01DK077785-04
Application #
7897663
Study Section
Special Emphasis Panel (ZDK1-GRB-R (J4))
Program Officer
Eggers, Paul Wayne
Project Start
2007-07-01
Project End
2012-05-31
Budget Start
2010-06-01
Budget End
2011-05-31
Support Year
4
Fiscal Year
2010
Total Cost
$252,131
Indirect Cost
Name
University of Pittsburgh
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Jhamb, Manisha; Abdel-Kader, Khaled; Yabes, Jonathan et al. (2018) Comparison of fatigue, pain and depression in patients with advanced kidney disease and cancer - symptom burden and clusters. J Pain Symptom Manage :
Gemmell, Leigh A; Terhorst, Lauren; Jhamb, Manisha et al. (2016) Gender and Racial Differences in Stress, Coping, and Health-Related Quality of Life in Chronic Kidney Disease. J Pain Symptom Manage 52:806-812
Sharma, Akhil; Yabes, Jonathan; Al Mawed, Saleem et al. (2016) Impact of Cognitive Function Change on Mortality in Renal Transplant and End-Stage Renal Disease Patients. Am J Nephrol 44:462-472
Abdel-Kader, Khaled; Jhamb, Manisha; Mandich, Lee Anne et al. (2014) Ecological momentary assessment of fatigue, sleepiness, and exhaustion in ESKD. BMC Nephrol 15:29
Jhamb, Manisha; Unruh, Mark (2014) Bidirectional relationship of hypertension with obstructive sleep apnea. Curr Opin Pulm Med 20:558-64
Jhamb, Manisha; Liang, Kelly; Yabes, Jonathan et al. (2013) Prevalence and correlates of fatigue in chronic kidney disease and end-stage renal disease: are sleep disorders a key to understanding fatigue? Am J Nephrol 38:489-95
Unruh, Mark L; Larive, Brett; Chertow, Glenn M et al. (2013) Effects of 6-times-weekly versus 3-times-weekly hemodialysis on depressive symptoms and self-reported mental health: Frequent Hemodialysis Network (FHN) Trials. Am J Kidney Dis 61:748-58
Jhamb, Manisha; Unruh, Mark L (2012) Volume overload as a mechanism for obstructive sleep apnea in CKD? Nephrol Dial Transplant 27:1291-3
Abdel-Kader, Khaled; Dohar, Sheena; Shah, Nirav et al. (2012) Resistant hypertension and obstructive sleep apnea in the setting of kidney disease. J Hypertens 30:960-966
Parthasarathy, Sairam; Fitzgerald, MaryPat; Goodwin, James L et al. (2012) Nocturia, sleep-disordered breathing, and cardiovascular morbidity in a community-based cohort. PLoS One 7:e30969

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