Home Up



Nocturnal Home Haemodialysis

A Brief Overview


Comparison with conventional haemodialysis





This overview:

·       Reviews conventional haemodialysis (CHD)

·       Asks ‘Can dialysis be made better?’

·       Introduces nocturnal haemodialysis (NHHD)

o     The benefits

o     The risks

o     Who is suitable


… And if you think NHHD might be for you, recommends you return to take in the full experience of "A Comprehensive Look at Nocturnal Home Dialysis"


Conventional haemodialysis


Conventional haemodialysis:

·       Has traditionally been a day-time treatment

·       Is often poorly tolerated and causes a number of unpleasant side-effects

·       Has poor outcomes for many patients

·       Uses methods for improving the ‘adequacy’ of dialysis which focus on increasing the aggressiveness of the dialysis treatment rather than making it more gentle




·       CHD is usually given for 3 sessions/week and for  ~4 hrs/session and as a daytime treatment

·       CHD must remove all the waste and fluid that has been retained in the body over a 2-3 day period, yet do all this in the short space of ~4 hrs

·       The rapid waste and fluid removal rate of CHD leads to many side-effects (cramp, nausea, vomiting, falling blood pressure and fainting and after-treatment exhaustion)


Can dialysis be made better?


CHD can only be made more gentle by:

1.  Significantly increasing the length of each treatment time

2.  Increasing the number of treatments per week

or, even better …increasing both!


This is only possible, practical and acceptable to lifestyle if dialysis could be done during sleep.  Combine that with the fact that recent thinking has challenged traditional practices and NOCTURNAL HOME HAEMODIALYSIS emerges as the obvious solution.



Nocturnal home haemodialysis


Nocturnal home haemodialysis:

·       Is long, slow, gentle, self-performed dialysis

·       Is undertaken at home after a quiet dialysis machine has been installed in the bedroom

·       Can be done anywhere from every alternate night through to 6 or 7 nights per week

·       Delivers up to 4 times the amount of dialysis

(8-9 hrs/treatment, 6-7 nights/wk = 50-60 hrs/wk compared to the ~12 hrs/wk for CHD)


Benefits include:

·       No more of the usual side-effects of CHD

·       No more ‘crashes’ from falling blood pressure

·       No fluid, dietary or potassium restrictions

·       No need for phosphate binding medicines

·       No need for BP medication for most patients

·       No need for a dialysis partner – solo home overnight dialysis is not only possible, it is practical to use NHHD in un-partnered people.  NOTE:  The acceptance of unpartnered home dialysis remains controversial in some centres and this may be subject to local conditions and practices.


Further benefits include:

·       Stress on the heart is diminished

·       Calcium deposits in blood vessels regress

·       Sleep patterns normalize to refreshing rest

·       Sleep apnoea improves or resolves

·       Thinking clears and memory improves

·       Sexual drive/function improves


And the biggest benefits of all:

·       Day-time and waking hours are given back

·       Day-time activities return to normal without dialysis interference

·       Energy to work and work capacity is restored

·       Employment opportunity is again equal with those who are not on dialysis

·       Independence and self-esteem is restored



Potential risks include, but are yet to demonstrate:

·       ‘Over-dialysis’ – the inadvertent removal of essential substances by prolonged filtration

·       Access disconnection or infection

·       Blood or fluid loss whilst asleep

·       Heparin-related osteoporosis

·       Technique ‘burn-out’


…Though all are potential risks, none have yet occurred


Who is suitable for NHHD?


·       All home CHD patients

·       Many satellite or limited care CHD patients

·       As dialysis partners are not necessary, solo CHD patients without partners are suitable

·       Both AV fistula and catheter access patients

·       People with ‘sick hearts’ potentially do better and should be considered

·       Up to 30-40% of all CHD patients suitable

·       Where possible, patients identified as suitable for home dialysis during pre-dialysis education and discussion should have home therapies discussed with them and be trained directly into NHHD without ever experiencing the personal/emotional confinement of a dialysis unit.



If this brief overview interests you, I strongly recommend you return to "A Comprehensive Look at Nocturnal Home Dialysis" which discusses in language you will understand …


How dialysis got to where it is now

How dialysis works

The differences between CHD and NHHD

The details of NHHD and how it is safe to do at home

Our program in Geelong – a real outcomes study


Home Up


Authored by Prof John Agar. Copyright © 2012
Nocturnal Haemodialysis Program, Barwon Health.
All rights reserved. Revised: July 1st 2012