Hemodialysis treatment time: a fresh perspective.

Historical, clinical, economic, and technological developments have driven a shift in clinical practice from predominantly 6-hour-long hemodialysis treatments to much shorter treatment times that are prevalent today. Patients, physicians, and providers had considered shortening dialysis treatments as a means to decrease the overall burden imposed by this necessary life-saving therapy. However, shorter dialysis is not a panacea and may engender trade-offs in terms of patient morbidity and mortality. We examine the literature with the benefit of hindsight and in light of recent studies that have improved understanding of the complex relationship between dialysis dose and outcome. We touch upon the role of dialysis frequency relative to treatment time. We conclude with the suggestion that a new treatment paradigm should consider a minimum adequate dialysis treatment time of 4 hours for the majority of patients, with anything shorter becoming the exception rather than the rule.