Abstract
IN RECENT YEARS there has been great interest in studying the effect of dialytic dose on patient outcomes. This interest is based on the concept that a greater dialytic dose results in greater toxin removal, which in turn results in improved patient outcomes. Attempts to increase dose delivery in conventional thrice weekly hemodialysis (HD) by increasing dialysis efficiency with higher blood flow rates and high-flux membranes did not result in improved overall survival in the HEMO Study. 1 Eknoyan G. Beck G.J. Cheung A.K. et al. Hemodialysis (HEMO) Study GroupEffect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med. 2002; 347: 2010-2019 Crossref PubMed Scopus (1559) Google Scholar This clearly indicated that the currently accepted single-treatment target dose was not just that necessary for dialysis adequacy but is also the optimal affordable by such an intermittent therapy. Thus, interest has turned to the possible effect of increasing dialysis frequency; this interest appears to be growing worldwide. Short-duration, high-efficiency (SDHD) and long-duration, slow daily nocturnal hemodialysis (NHD) regimens are the 2 most common forms in use. Occasionally hybrid or combinations of SDHD and NHD are employed. Most reports describe SDHD and NHD as home-based therapies; SDHD has also been used in dialysis centers.
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