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There is also interest in nocturnal dialysis, which involves dialyzing a patient, usually at home, for 8–10 hours per night, 3–6 nights per week. Nocturnal in-center dialysis, 3–4 times per week, is also offered at a handful of dialysis units in the United States.
Most patients treating themselves "daily" (6x/week) with daytime hemodialysis use session lengths of 2–3 hours. Longer session lengths give more benefit in terms of fluid and especially, phosphate removal. However, unless sessions are prolonged beyond 3–4 hours, almost all 6x/week patients will still require phosphate binders.
Studies have demonstrated the clinical benefits of dialyzing 5 to 7 times a week, for 6 to 8 hours. This type of hemodialysis is usually called nocturnal daily hemodialysis and a study has shown it provides a significant improvement in both small and large molecular weight clearance and decreases the need for phosphate binders. [11]
For a US perspective, see the KDOQI clinical practice guidelines [10] and for a United Kingdom perspective see: U.K. Renal Association clinical practice guidelines [11] According to the US guidelines, for thrice a week dialysis a Kt/V (without rebound) should be 1.2 at a minimum with a target value of 1.4 (15% above the minimum values). However ...
For Thomas and the nearly 520,000 Americans who rely on dialysis, the experience can be uncomfortable, time-consuming, and fraught with health risks.
The first patient trained was in April 1994. Conventional hemodialysis consists of a patient traveling to a clinic three times per week for a four-hour treatment. With nocturnal hemodialysis patients are trained to provide the treatments in their home six or seven nights per week for six to eight hours per treatment.
Before implementing continuous renal replacement therapy (CRRT), acute renal failure (ARF) in critically ill, multiple organ failure patients was managed by intermittent hemodialysis and the mortality rate was very high. [4] Hemodialysis is effective in clearance and ultrafiltration, but it has deleterious effects on hemodynamic stability. [5]
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