Daily nocturnal hemodialysis as pioneered in Toronto during the 1990’s is 6 nights per week, 6 to 8 hours. This has the twin advantages of both longer and more frequent treatment. This absolutely maximizes the health benefits. When you do it this way, you can kiss diet and fluid restriction goodbye, and this is no exaggeration.
From what I can tell in my program (and I am on daily nocturnal now, 6 nights), the choice of treatment time from 6 to 8 hours has little to do with patient weight or anything like that (although I guess it might in some cases). It’s more a personal choice. Say you choose 6 hours. That means you either have to start very late (when you might be already too sleepy to setup the treatment), or you have to get up very early. With a 6 hour treatment, if you’re on treatment at 11, that means the treatment ends at 6am, not including post-treatment time. A person wanting to go to bed at 10 would have to get up at 5am. So, a person might prefer to be on treatment for 7 or 8 hours in order to not have to get up so early, or to start treatment earlier.
I’m not sure what advantages there would be to doing nocturnal treatments only 3 or 4 times per week, other than freeing up daytime. If you do it less than 6 times, or at the very least, 5 times per week, then you have to watch the fluid and what you eat more on those off days. Would it be worth the trouble of doing nocturnal 4 nights per week? Hard to say. To me, it doesn’t seem that different than people who are already doing in-centre 3 times per week for 5 hours. I know quite a few who have to do this, because 4 hours isn’t long enough for their needs. I don’t think there is much data or empirical experience with that. Having been on 3/week in-centre (3-1/2 hours a treatment for me) for 3 years, I’m not sure it would be worth having to sleep at a dialysis centre 4 nights per week. Now, if you’re doing it at home, it’s a different story, but then, if you ARE doing it at home, a person may as well do 5 or 6 nights per week and get the full advantage, otherwise, what’s the point, really. No matter what machine a person uses, it’s a lot of effort to manage ones’ own hemodialysis at home. There’s the treatment itself, the needles, etc., but there’s also managing and storing the supplies, and there’s no guarantee that everything always goes well. It can be a little stressful at times. I wouldn’t want to bother if it didn’t give me the dietary and fluid advantages I’ve talked about. It just wouldn’t be worth the trouble.
I can understand how people who haven’t had the experience with daily nocturnal hemo might be skeptical, but, as I said before, except for having to actually do the dialysis, it’s like not having kidney failure at all. The fewer treatments you have per week, the farther away you get from that.
At my home hemo unit, they expect to start in-centre short daily in the near future. I could see that as a reasonable alternative for people who can’t do it themselves at home for whatever reason, but I’m not sure I would want to have to sleep 4 nights per week at a dialysis centre.