Frequent prolonged home haemodialysis: three old concepts, one modern solution.

Most haemodialysis patients are, even when treated ‘adequately’ according to current standards, exposed to the so-called unphysiology of dialysis, which was described more than 25 years ago [1]. They are still at high risk of being overhydrated and dehydrated, hypertensive and hypotensive, acidotic and alkalotic, or hyperkaliaemic and hypokaliaemic thrice weekly. Furthermore, most patients are treated in an unfamiliar hospital setting where they are confronted with illness and death of fellow patients and chronic lack of time of overworked professionals, resulting in neglect of attempts of patients to self-determination. Despite many good evidence-based protocols and standards, current chronic intermittent haemodialysis is associated with high mortality and morbidity and low quality of life, and hardly deserves the adjective ‘adequate’. Dialysis should be referred to as ‘adequate’ when it results in normal life expectancy, normal morbidity, normal quality of life and the absence of dialysis-associated symptoms. We are challenged to turn such visions of adequate treatment into reality. The old concepts of frequent ‘daily’ haemodialysis [2,3], prolonged haemodialysis [4], and the combination of both, ‘nocturnal’ haemodialysis [5], can guide us in our attempts to improve dialysis outcome. For logistical and practical reasons, frequent and nocturnal haemodialysis are preferably performed at home, and another old concept, home haemodialysis, deserves serious attention and revival.