Advantages and limitations of Long Nocturnal Hemodialysis (LNHD)

Abstract

Intermittent long nocturnal hemodialysis (LNHD) combines dialysis and sleep. Its clinical advantages are a reduced ultrafiltration rate, better control of blood volume with improved tolerance of the sessions and cardiac performance, better clearance of phosphates and middle molecules, and better survival in cohort studies. Quality of life is not impaired by the length of the sessions and, when not optimal, improves when transferring from standard hemodialysis (HD) to LNHD. The quality of sleep is sometimes disturbed, but it is not an important cause of exit from the program. The sustainability of an LNHD program depends on the joint medical and managerial will, the selection of stable patients, respect for schedules, and the duration of sessions, which is essential for sleep dialysis. The health authorities must play a role in allowing this modality under acceptable financial conditions. Informing the patient of the existence of LNHD before the dialysis stage is essential, helped by the testimony of peers. Learned societies should support research and the provision of information to nephrologists. Finally, architectural conditions that promote privacy and sleep are key to the success of the program.