Providing an in-centre nocturnal hemodialysis program: the pearls and pitfalls.

Home nocturnal hemodialysis (HNHD) has been demonstrated to provide a number of benefits for patients on chronic hemodialysis including improvements in dialysis adequacy blood pressure control, cardiac function, hemoglobin, and mineral metabolism status (Chan, 2004; Pierratos, 2004). Unfortunately a large number of chronic HD patients are unable to manage HNHD due to a variety of medical and social challenges. At St. Michael's Hospital in Toronto, we designed and implemented an innovative in-centre nocturnal hemodialysis (INHD) program for patients who were unable to manage HNHD and/or who had inadequate phosphate control that was resistant to conventional therapy In our unique program, nurses from the inpatient nephrology unit were taught to deliver nocturnal hemodialysis in the renal unit. Patients receive dialysis three nights per week for approximately seven hours each treatment. Follow-up by the multidisciplinary team is conducted every two to three months. The program has generated favourable patient feedback and demonstrated significant benefits for patients including improved phosphate control and improved per cent reduction of urea (PRU) values. Ongoing challenges include maintenance of nursing staff competencies due to a limited number of rotations in hemodialysis, movement of beds into dialysis stations for the night shift, and scheduling of follow-up clinics. This article will outline both the successes and challenges of this unique approach to hemodialysis.