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Technical aspects of nocturnal hemodialysis

Andreas Pierratos, MD, FRCPC
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD


The mortality rate of patients undergoing maintenance hemodialysis is unacceptably high [1]. An extremely high morbidity, relatively low quality of life (due in part to a high level of dependence and unemployment), and high cost of care have also been observed.

Instituting more intensive dialysis regimens appears to improve morbidity and possible mortality in this patient population. Compared with conventional, three times per week regimens, for example, dialysis associated with longer duration and/or higher frequency correlates with enhanced outcomes [2-7]. However, the Hemodialysis (HEMO) study found that increasing the dialysis dose within the general restrictions of a thrice-weekly regimen failed to decrease patient mortality [8-10]. (See "Patient survival and maintenance dialysis" and "Prescribing and assessing adequate hemodialysis".)

Given these findings, nocturnal hemodialysis (eg, long nightly home hemodialysis) was introduced as a (possibly) more desirable alternative to conventional dialysis since it provides superior dialysis, based upon dose, duration, and frequency. This can be accomplished because it is performed during nightly sleep, an otherwise unproductive time [11].

Although Shaldon is credited for overnight dialysis at home [12], Uldall started the first quotidian (daily) nocturnal hemodialysis program in 1994 in Toronto [11,13]. Since then, its use has been extended to more centers in Canada, the United States, Australia, and several European countries [14-17].

A description of nocturnal hemodialysis, particularly the exact regimen associated with the procedure, will be presented here. Outcomes associated with nocturnal hemodialysis and an overview of short daily hemodialysis are presented separately. (See "Outcomes associated with nocturnal hemodialysis" and "Short daily hemodialysis".)

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Literature review current through: Nov 2017. | This topic last updated: Aug 20, 2017.
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