Daily and nocturnal hemodialysis: How do they stack up?

A growing number of articles in the literature describe experiences using m ore frequent hemodialysis (HD), either short daily or long nocturnal. Most of these publications highlight successes obtained by these programs with a fragmented look at specific areas and outcomes. This review of published r esults from the use of these therapies shows that universal improvement is noted in dialysis adequacy, nutrition, quality of life, blood pressure cont rol, fluid and electrolyte balance, and hospitalizations when these paramet ers are mentioned. However, data reporting is often incomplete. Most studie s do not have adequate control groups, patient populations are often differ ent from the standard HD population, and many have small numbers that precl ude statistical significance. Nonuniformity of patient selection and study design prevents accurate comparison and pooling of patient data. In some ca ses, the same patients' data for the same periods of observation are report ed in several studies. Despite data that can be characterized as preliminar y and anecdotal, the results reported in this review show remarkable patien t improvement worthy of serious consideration by the renal community. To re ach a level of evidence that will be widely acceptable, the renal community needs to partner with such government institutions as the National Institu tes of Health and the Health Care Financing Administration to study systema tically the outcomes and costs associated with using more frequent HD. In t he process, important ramifications of such a cooperative study, including potential changes in policy, need to be considered. (C) 2001 by the Nationa l Kidney Foundation, Inc.