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Three times each week, Ramona David would show up for work at 10 a.m. – after having spent 3 ½ hours undergoing hemodialysis (HD) because of her kidney failure. The shorter treatment time left her tired and made it more difficult to control her blood pressure.
“Sometimes it was pretty harsh going to work right after dialysis,” recalled Ramona, an admissions and program manager at Case Western Reserve University (CWRU). “I have a wonderful boss and coworkers who are very supportive of my medical needs. But I had some really long days.”
These days, her daytime schedule is back to normal. That’s because Ramona now undergoes dialysis during the night at Cleveland Clinic East, a joint venture of Cleveland Clinic, Fresenius Kidney Care and the MetroHealth System operating as Ohio Renal Care Group.
Her in-center nocturnal intermittent hemodialysis (NIHD) is completed in seven- to eight-hour overnight sessions instead of the usual three- to five-hour daytime sessions. Longer treatments increase the amount of waste removed from patients while better controlling anemia and other possible complications. Importantly, it also allows individuals like Ramona – who are awaiting a kidney transplant — more freedom during daytime hours for work, family and other activities.
“As patients and nephrologists become more aware of its benefits, nocturnal HD is becoming more popular,” said Evamaria Anvari, M.D., a nephrologist at the Cleveland Clinic Glickman Urological & Kidney Institute’s Department of Nephrology and Hypertension.
Ramona switched to nocturnal HD when the new facility opened earlier in 2018, and arrives for her treatment at 7:30 p.m. on Sunday, Tuesday and Thursday nights. She undergoes HD in a private pod, or station, in a heated and reclining chair. Further, she and the other patients benefit from one of the nation’s most advanced, ultra-purified water filtration systems for HD.
“I get all set up with my pillow, blanket and headphones. It’s extremely comfortable,” noted Ramona. “Once the nurse puts the needles in, I get in my own little world and just relax.”
Ramona usually dozes off and on throughout the night. The session ends at 2:30 a.m., she’s home by 3:15 a.m. and sleeps a few more hours before heading to work – on time and refreshed.
“I feel a lot better afterward. The nurses tell me I look so well rested,” added Ramona. “Nocturnal has been a real godsend for me. I’m not rushing all the time anymore.”
According to Dr. Anvari, the increased demand for HD in the United States in recent decades made scheduling more difficult, resulting in patients receiving shorter treatments. However, research revealed reduced dialysis times correlated with increased death rates among HD patients. This has led to a return to slower, longer-lasting dialysis treatments and the need for centers like Ohio Renal Care Group, as well as another nocturnal HD facility in Brook Park, Ohio.
“Dialysis patients now have more choices,” added Dr. Anvari. “They can decide how much time and effort they are willing to dedicate to dialysis, in exchange for better health outcomes.”
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Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. Cleveland Clinic is consistently recognized in the U.S. and throughout the world for its expertise and care. Among Cleveland Clinic’s 81,000 employees worldwide are more than 5,743 salaried physicians and researchers, and 20,160 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,690-bed health system that includes a 173-acre main campus near downtown Cleveland, 23 hospitals, 276 outpatient facilities, including locations in northeast Ohio; Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2023, there were 13.7 million outpatient encounters, 323,000 hospital admissions and observations, and 301,000 surgeries and procedures throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 132 countries. Visit us at clevelandclinic.org. Follow us at twitter.com/CleClinicNews. News and resources available at newsroom.clevelandclinic.org.
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