Back Home Next




(Terms shown in red throughout the text are explained in the glossary.  If they are underlined, hold your cursor over the word or phrase for a fuller explanation).


n       Most dialysis information on the web deals with standard, conventional forms of dialysis treatment

n       In the last decade, however, a quiet revolution has occurred as it has been increasingly recognized that …

n       Usual dialysis is short and aggressive. Sadly, it often yields a poor outcome for patients, both in symptom relief (or lack of it) and in lifestyle management

n       Dialysis outcomes are inversely related to dialysis length (hours) and frequency (times per week). Short, infrequent therapy unfortunately often ensures lesser outcomes than can be achieved through longer, more frequent treatment

n       It has become clear that the best way to increase both dialysis time and frequency is to dialyse through the night, and at home

n       This website is all about showing you …

n       How this can be achieved

n       How it can be done safely

n       What benefits might accrue


The origins of Nocturnal Haemodialysis

n       After some early experience in the 1960's with dialysis overnight (Shaldon in London and Scribner in Seattle), the modern era of more frequent haemodialysis at home and at night took root in 1993, pioneered by Drs Robert Uldall and Andreas Pierratos, in Toronto, Canada

n       Quietly, though, Bernard Charra (Tassin, France) had continued to offer overnight dialysis through the 70's and 80's though sadly few took notice

n       They showed us clearly that, as dialysis time lengthens and its frequency is increased, dialysis-related symptoms are abolished and lifestyle outcomes are improved dramatically … in many and varied ways

n       Several centres around the world – including our own – are now using the technique they first called ‘Nocturnal Haemodialysis’ (NHD)

n       Why did we, with others, join the NHD ‘revolution’? Well, simply put …

n       Because we wanted to provide better dialysis whenever we could

… And

n       We did not believe providing ‘adequate’ dialysis was good enough

n       Currently, ‘good’ dialysis is judged by a flawed concept of ‘dialysis adequacy’. A whole industry and literature has been built around providing and measuring ‘adequate’ dialysis … but we believe that ‘adequate’ is not the same as, nor as good as, ‘optimum’

n       This website will show you how we believe ‘optimum’ dialysis can be appoached

n       We strongly believe ‘optimum’ and not ‘adequate’ dialysis should be the ideal goal.


Adequate vs. Optimum

It is vital that the difference between ‘optimum’ and ‘adequate’ is well understood!

n       Adequate is defined in the Oxford Dictionary as ‘satisfactory’

But …

n       Optimum is defined as ‘best achievable

n       In Geelong, we believe in striving to provide our patients with what is best, not just what is good enough

n       So … how were we led to accept the concept of ‘adequacy’ and a goal of ‘adequate’ and not the more appropriate ideal of ‘optimum’ as a measure of dialysis efficiency …?

n       To understand this, it is both interesting and essential to have some knowledge of dialysis history …


Back Home Next


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