A Brief History of Daily Hemodialysis.

Daily hemodialysis has been in uninterrupted practice since its introduction in California in 1967. Early trials were stopped for technical, logistical, and economical problems, but a rapidly increasing number of centers now perform it on close to 200 patients, either as long nightly or short daytime hemodialysis. Increasing the frequency of dialysis appears much more important in improving patient well-being than increasing the Kt/V dose, and patients quickly experience much more vigor, energy, and improved quality of life when starting daily hemodialysis. Blood pressure improves, and medications can often be discontinued. Similarly, the need for erythropoietin decreases, and nutrition and dry body mass increase. While the cost of dialysis increases, the total cost for a patient decreases as medications and hospitalizations decrease. Technical innovation will solve the logistical problems by letting a machine do the labor necessary to begin and end a dialysis session. Access problems have decreased for native fistula, and the other access types have not been studied enough.