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Outcomes associated with 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 have also been observed [2].

The Hemodialysis (HEMO) and Adequacy of Peritoneal Dialysis in Mexico (ADEMEX) trials found that increasing the dialysis dose within the general restrictions of a thrice-weekly regimen or of peritoneal dialysis, respectively, failed to decrease patient mortality [3-6] (see "Patient survival and maintenance dialysis" and "Prescribing and assessing adequate hemodialysis"). The institution of more intensive dialysis regimens provided evidence of improvement in 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 correlated with enhanced outcomes [7-11].

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 [12].

Although Sheldon is credited for overnight dialysis at home [13], Uldall established the first quotidian (daily) nocturnal hemodialysis program in 1994 at the Wellesley Hospital in Toronto [12,14]. Since then, its use has been extended to more centers in Canada, the United States, Australia, and several European countries [15-18].

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

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Literature review current through: Nov 2017. | This topic last updated: Apr 21, 2017.
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