Is there a magic in long nocturnal dialysis?

Long 3 X 8 h/week hemodialysis (HD) has been used without modification in Tassin since 35 years with very satisfactory morbidity and mortality results. It can be performed in the day or overnight. The observed good outcome is mainly due to lower cardiovascular morbidity and mortality than usually reported in HD. This, in turn, is due to the good control of blood pressure (BP) and of serum phosphate level. The control of BP results from the strict extracellular volume normalization using an adequate ultrafiltration and a low salt diet. High doses of small and middle molecules lead to a satisfactory nutrition, correction of anemia, control of serum phosphate and potassium with minimal needs for medications. The treatment is cost-effective. It provides an optimal dialysis i.e. it corrects as perfectly as possible each abnormality of renal failure. Overnight dialysis is the most logical way of delivering long HD with the lowest possible hindrance on patient's life. Due to the change in case mix a decreasing number of patients are apt or willing to go on overnight dialysis; education to autonomy is more difficult, but the benefits are still there.