Nocturnal hemodialysis: an underutilized modality?

Abstract

There is increasing evidence that extended-hours regimens are associated with improved outcomes for patients on maintenance hemodialysis programs. Home hemodialysis programs are a well established way for patients to benefit from extended-hours dialysis overnight; however, there are significant barriers to home hemodialysis, which means that for many this is not an option. In center, nocturnal hemodialysis is an increasingly recognized way of offering extended-hours treatment to patients unable to undertake home-based programs and is an underutilized modality for such patients to gain from the physiological benefits of extended-hours dialysis regimens. Recent data suggest that nocturnal dialysis programs confer a significant survival advantage over both standard dialysis and short-daily dialysis regimens with evidence proposing that this is mediated through beneficial cardiovascular remodeling. Moreover, there is strong evidence that nocturnal dialysis regimens associate with significant improvements in quality-of-life measures and social well being. Nocturnal hemodialysis is an underutilized way of offering extended-hours hemodialysis to patients in both the home and in-center environments. As the evidence base around nocturnal dialysis grows, clinicians and dialysis providers are becoming increasingly obliged to investigate implementation strategies for nocturnal dialysis services to improve patient outcomes and experience of care.