Abstract:
 What constitutes adequate dialysis has been debated in the nephrology literature over the past eight years. The mortality rate of patients on dialysis in the United States is about 20% per year. We believed that short and infrequent dialysis sessions contributed to poor outcomes. To improve the results, Lynchburg Nephrology started the Nightly Home Hemodialysis (NHHD) program in September of 1997.
     Ten patients were trained in the first 15 months of the program. Patients dialyzed 7 to 9 hours, 6 nights per week using the Fresenius 2008H machine. A standard dialysis solution with 2.0 mEq/L potassium, calcium concentration of 3.0-305 mEq/L was used. Dialysis solution flow rate were 200 to 300 mL/min. Serum phosphate levels are maintained above 2.5mg/dl by adding 0 to 45 mL Fleets Phosphosoda to the bicarbonate bath.
     Patients have marked improvement in quality of life as measured with the SF-36. Blood pressure was better controlled with fewer medications. All phosphate binders were eliminated. Calorie intake and protein intake increased to normal levels as measured by three day dietary histories pre-NHHD, and at 3, 6 and 12 months on NHHD.
     Epoetin alfa dosages were been reduced by about 50%.
     Nightly home hemodialysis should be considered as a valuable modality option for end-stage renal disease patients; it is potentially superior to conventional thrice-weekly hemodialysis.

(Home Hemodial Int, Vol. 3, 23-28, 1999)

Key Words
Nocturnal hemodialysis, anemia, phosphate control, blood pressure control, adequacy of dialysis, nutrition

Introduction:

Lynchburg Nephrology started its nightly home hemodialysis (NHHD) program in September 1997, based on reports of Pierratos et al. {1,2), which presented excellent results of nocturnal hemodialysis as a better option for patients with end-stage renal disease (ESRD) {3,4}. The literature reports that daily hemodialysis offers a higher quality of care for patients at an overall lower cost to the Medicare ESRD (end-stage renal disease) program {5}. In the United States, the mortality rate of 20% for ESRD patients exceeds that of patients with breast cancer or prostate cancer {6}. Lynchburg Nephrology staff visited Pierratos in Toronto, Canada, to witness his program, and we interviewed six of their 13 NHHD patients. An interdisciplinary NHHD team was created; comprised of patients and their families, nurses, social workers, a dietician, a machine maintenance technician, an information systems coordinator, the facility administrator and physicians. After a 5-month set up time, the program was implemented.

Methods:

Hospital data were collected from September 4, 1997 wo december 5, 1998, and clinical data were collected from September 4, 1997 to December 31, 1998.