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Exercise is an important treatment for type 2 diabetes

Frequent haemodialysis at night may be better than traditional three times a week treatments, according to a preliminary trial from Canada. The 52 participants were all patients on long term dialysis, mostly in self care or home dialysis programmes. Patients who switched to six overnight sessions a week had a significantly lower left ventricular mass than controls after six months (difference 15.3 g, 95% CI 1.0 to 29.6). They also had lower systolic blood pressure (adjusted mean difference 14 mm Hg, 3 to 26), and they were more likely to have reduced or stopped their antihypertensive drugs. The new regimen had no effect on overall quality of life, but the authors found a clinically relevant improvement in quality of life related to kidney disease. The trial was too small to look at the effect of nightly haemodialysis on mortality or cardiovascular events. But left ventricular mass is a reasonable surrogate for the moment, say the authors. Bigger trials are on the way, although none aims to recruit anything like the 5000 patients needed to establish for certain whether frequent night time dialysis can save lives. Up to 20% of patients on dialysis die each year, says an editorial (p 1331). A statistic that has remained virtually unchanged for more than a decade. JAMA 2007;298:1291-9