Nocturnal In-Center Hemodialysis

Nocturnal in-center HD is not a home treatment. We mention it, however, because it gives you twice as much treatment as standard in-center HD. With cleaner blood, you can feel better and have more energy. You won't need such strict diet and fluid limits, and may need fewer medicines. And, you don't need a partner.

The long, gentle treatments last for about 8 hours in the clinic. Most clinics start these treatments at about 8pm, and they end at about 4am. A few clinics offer the longer treatments at about 3pm so you can go home when you're done and sleep in your own bed. We like this idea and hope it catches on.

Nocturnal in-center HD benefits in brief:

• Convenient – Have your days free
• Energy – Twice as much dialysis for more energy, libido, and appetite
• Gentle – This treatment is very easy on your heart
• Freedom – Eat and drink more of what you like and make fewer trips to the clinic
• Survival – You may live longer than with standard in-center HD

Getting ready for nocturnal in-center HD:

To do any type of HD, you will need a surgeon to make you a vascular access (a way to get blood to the dialyzer).

Where can you get nocturnal in-center HD?

Nocturnal in-center HD options are growing quickly. Of the more than 5,000 dialysis clinics in the U.S., about 5% offer it. Be sure to ask at your clinic. If they don't have a program yet, maybe they will start one if enough people want it. Find a center near you.

Time

Nocturnal in-center HD takes about 7–9 hours each time a treatment is done. Plus, you'll have travel time to and from the clinic. You probably won't have to wait for a chair, because fewer people are using this option.

Nocturnal in-center HD may be a good choice for you if you want to:

• Feel well most of the time. With long, gentle treatments, you may feel well just 10 minutes after a treatment.
• Dialyze without a partner. Since the staff helps you, you don't need to have a partner.
• Keep your job. Nocturnal in-center HD does not take time out of the work day, so it is work-friendly.
• Keep dialysis out of your home. Some people don't want machines and supplies in their home to remind them of dialysis.
• Eat and drink more normally. You may have few limits on fluid, potassium, sodium, and phosphorus—at least on treatment days. You will have a 2-day gap, and must take care.
• Swim or take tub baths. If you have a fistula or graft for access, you can swim and bathe after the needle sites scab over after a treatment.
• Avoid painful cramps. Long treatments are so gentle that cramping is very rare.
• Protect your nerves, joints, and bones. Long treatments remove far more of the "middle molecules" thought to cause nerve, joint, and bone damage.
• Protect your heart. Blood pressure is much lower with nocturnal in-center HD. It's gentler on your heart.
• Maintain a healthy sex life. People who get more HD say that their sex lives improve.
• Have a baby. There are not many studies on this. But, women who get at least 20 hours of dialysis a week seem to have a better chance of carrying a baby to term.
• Stay out of the hospital. People who do nocturnal HD are less likely to have hospital stays.
• Live longer. Studies have found that people who do nocturnal HD may live as long as those who get a deceased donor kidney transplant (3 times longer than with standard in-center HD).

Nocturnal in-center HD may not be as good of a choice for you if you want to:

• Avoid needles. All HD requires needles (unless you use a catheter, which is risky).
• Avoid a 2-day gap with no dialysis. Nocturnal in-center HD is only done 3 days a week.
• Sleep in your own bed. If you wouldn't feel right leaving a partner home alone, or can't sleep away from home, nocturnal in-center treatments may not be the best fit for you. Perhaps the clinic would offer a 3pm to midnight shift so you could go home to sleep.
• Feel in control of your treatments. In most cases, the staff do your treatments in-center. But, you can ask to learn how to put in the needles. If you train for in-center self-care, you may be able to do your own nocturnal treatments.
• Sleep during normal sleep hours. The 8pm to 4am schedule breaks up the night, which works well for some—but not as well for others.
• Travel. To travel, you need to set up dialysis with a clinic where you'll be going. You may be able to find an nocturnal in-center HD clinic where you're going. If not, you'd need to set up standard in-center treatments. And, to stay safe, you'll need to adjust your diet and fluid intake for getting half as much dialysis.

Who is best suited for nocturnal in-center HD?

If you can do standard in-center HD, you could do nocturnal in-center HD, too. Getting to and from the clinic can be a challenge if you can't drive yourself.