Home Nocturnal Hemodialysis - Reply

To the Editor: Home nocturnal hemodialysis (HND) has been an established form of treatment on a worldwide basis since its introduction in 19641,2,3,4. In its early days, many thought that it was superior to transplantation and was more cost effective than in center dialysis. Alas, the passage of time has not confirmed any of these earlier hopes. It is rarely practiced today for many reasons, including the increasing age and comorbidity of the end-stage renal population being maintained on hemodialysis, although I still have one patient who has performed HND 4 times a week for 33 years5. Unless the increase in frequency of HND to 5 to 7 times per week can really be shown to be applicable on a large scale in less than highly motivated patients and staff, I doubt that the aspirations and claims of McFarlane et al6 will stand the test of time more than our hopes and aspirations of 40 years ago.