Quotidian dialysis--update 2005

PURPOSE OF REVIEW: The interest in quotidian hemodialysis has increased further after the HEMO study reported that high-dose thrice-weekly hemodialysis failed to improve clinical outcomes. This, in combination with a significant volume of newly published data, made a review of the topic of quotidian hemodialysis timely. RECENT FINDINGS: The published research has revealed further evidence of cardiovascular and quality-of-life improvements as well as financial benefits with quotidian hemodialysis. Accrued worldwide experience has confirmed the previously published benefits of quotidian hemodialysis. There has been a significant effort by industry to produce patient-friendly machines for home hemodialysis. Reports on the use of daily hemodialysis and hemodiafiltration in children have appeared. An international registry of patients on quotidian hemodialysis has been created. The need for modification of the funding mechanisms and the lack of prospective randomized controlled studies on quotidian hemodialysis led to the funding of such studies by the National Institutes of Health in collaboration with Centers for Medicare and Medicaid services to be completed by 2008. The proper funding for daily home hemodialysis was secured in the province of British Columbia, Canada, and is under consideration elsewhere. SUMMARY: There is increasing evidence confirming that quotidian hemodialysis improves clinical outcomes in a cost-efficient manner. Provided that the reimbursement issues are resolved these modalities may be utilized extensively at home as well as in the in-center facilities. The revitalization of home hemodialysis will compensate for the decline in utilization of continuous ambulatory peritoneal dialysis and the nursing shortage encountered in most countries.