The impact of short daily and nocturnal hemodialysis on quality of life, cardiovascular risk and survival.

End-stage renal disease (ESRD) is a significant global health problem that places a considerable burden on health care resources. The leading cause of death in ESRD patients is cardiovascular disease, which is often preceded by changes in cardiac geometry, including left ventricular hypertrophy (LVH). Treatments that result in regression of LVH have been shown to lead to better clinical outcomes. Globally, most ESRD patients receive conventional hemodialysis (CHD) 3 times per week, but mortality rates remain high and quality of life (QoL) is poor. Increasing the frequency of HD to 5 or 6 times per week, either as short daily HD (SDHD) or nocturnal HD (NHD), can improve QoL, reduce cardiovascular risk and prolong survival, compared with CHD. Improvements in these end points are likely driven by enhancements in fluid management, blood pressure control, mineral metabolism and left ventricular mass regression. From a practical standpoint, SDHD and NHD are best delivered at home. Barriers to adoption of home HD are chiefly modifiable, and may include lack of a care partner or family support, fear of cannulation and access disconnection, and uncertainty in one's ability to learn the procedures required to perform self-HD. On a positive note, substantial progress has been made to overcome these and other perceived barriers.