Grant: Operating Grant

End-stage kidney disease occurs when the kidneys stop functioning and a person becomes dependent on dialysis or transplantation to remain alive. At present, this condition affects over 32,000 Canadians. To date, the best treatment option is kidney transplantation. Unfortunately the demand for transplantation greatly exceeds the organ supply, thus creating long wait-lists, waiting times, and death while waiting. Thus patients languish in conventional dialysis programs where their quality of life and their life-expectancy is substantially lower compared to transplantation. However, a novel dialysis strategy provides new hope: nocturnal home hemodialysis (NHD). NHD allows patients to administer their dialysis at home while asleep. They receive 3 to 4 times more therapy than with conventional dialysis, and experience dramatically improved clinical and biochemical outcomes, as well as quality of life compared to conventional hemodialysis. We have recently demonstrated that NHD patients have equal survival to deceased donor transplantation - in stark contrast to conventional dialysis where survival is inferior to transplantation. This prompted us to ask whether NHD also results in a similar quality of life as transplantation; this is the focus of our proposal. We aim to use four well characterized health questionnaires to assess quality of life among transplant recipients and patients undergoing NHD and hypothesize that quality of life will be similar between these patient groups and remain similar over time. This study is important since it will help clarify whether NHD is an appropriate alternative to kidney transplantation and diffuse pressure off transplant wait-lists. Knowing that survival is similar between these treatments, adding knowledge about quality of life will offer patients a more complete understanding of what their treatment trade-offs are. This study has the potential to affect the lives of thousands of kidney disease patients across Canada.