Slow nocturnal home hemodialysis at the Wellesley Hospital

To alleviate the overcrowding of in-center hemodialysis (HD) facilities, we have developed slow nocturnal home hemodialysis (SNHHD), an innovative form of renal replacement therapy. SNHHD is performed 5 to 7 nights/week for 8 hours, during sleep, with a blood flow of 300 mL/min and a dialysate flow of 100 mL/min. The vascular access is by means of the Uldall-Cook catheter, which allows for easy patient access with low infection rates. Special precautions were taken to prevent accidental disconnection during sleep. Dialysis functions were monitored via a modem from the patient's home to the SNHHD center and have proven valuable in increasing patient confidence. The removal of urea, phosphate, and B2 microglobulin (B2M) during 1 week of SNHHD greatly exceeds that of thrice weekly conventional HD. Five patients have completed training and have been successfully performing SNHHD for 6 to 16 months. All patients have discontinued phosphate binders and increased dietary phosphate intake. Four out of five patients report sleeping soundly and experience greatly increased energy and stamina. Repeated in situ reuse of the dialyzer and the blood lines will reduce the patients work and make SNHHD a very inexpensive modality.