Daily (quotidian) nocturnal home hemodialysis: Nine years later


  • Andreas Pierratos

    Corresponding author
    1. Humber River Regional Hospital, Associate Professor of Medicine, University of Toronto, Toronto, Ontario, Canada
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Andreas Pierratos, MD, FRCPC, Head, Home Hemodialysis, Humber River Regional Hospital, 200 Church Street, Weston, Ontario, Canada M9N 1N8.
E-mail: a.pierratos@utoronto.ca


Daily nocturnal home hemodialysis was developed to satisfy the need for a highly effective, smooth, and cost-effective home dialysis therapy. It combines the benefits of the following dialysis methods: long, frequent, and home hemodialysis. It provides a high dialysis dose for small, as well as large, molecules including β2-microglobulin; improves quality if life; and leads to control of hyperphosphatemia without the need for phosphate binders, as well as dissolution for extraosseous calcifications. Furthermore, it controls blood pressure often without medications, is associated with regression of left ventricular hypertrophy, improves cardiac function, improves anemia as well as nutrition, allows an unrestricted diet, and corrects sleep apnea. Finally, it decreases the overall cost of patient care and improves cost utility when compared to conventional hemodialysis. The main obstacle to its wider utilization is the structure of the current reimbursement system. Along with short daily hemodialysis, long intermittent dialysis, and the convective dialysis techniques, daily nocturnal hemodialysis promises to improve dialysis outcomes.