Nocturnal home hemodialysis in north america

Abstract

Nocturnal home hemodialysis (NHD) was made possible in the 1960s by fail-safe monitoring, the Scribner shunt, and low-resistant Kiil dialyzer allowing hemodialysis without a blood pump. In London, Sheldon was the first to use overnight home hemodialysis. The Lynchburg NHD program and Lisa Murphy, a dietician in Bender's NHD program in Kansas City, developed a questionnaire for short daily hemodialysis and NHD. The questionnaire was sent to all known daily hemodialysis programs in North America. Some advances in nocturnal home hemodialysis since 1994 include: improvement in teaching methods, preventing disconnects and air emboli, preventing catheter infections, and using arteriovenous fistulas and grafts for access. As of January 2001, there were 13 centers in North America performing daily nocturnal home hemodialysis caring for 115 patients. Since 1997, all programs performing NHD have validated Pierratos' reported results, showing improvement in quality of life, better blood pressure control with fewer medications, reduced Epogen usage, reduced hospitalizations, control of phosphorous without binders, and a greater sense of hope for patients. Even though this new modality is safe and better for selected patients with ESRD, dialysis providers in Canada and the United States cannot afford to offer NHD within the present reimbursement scheme. © 2001 by the National Kidney Foundation, Inc.