[Daily/nocturnal hemodialysis: only for the happy few or a real alternative for many?].

: After the negative results of the HEMO study there is renewed interest in alternative, more ''physiological'' dialysis schemes, such as short daily or nocturnal dialysis. Considerable experience has been acquired with short daily hemodialysis, especially in Italy and the Netherlands. Nocturnal daily hemodialysis is mostly performed in Canada, the USA and Australia. Long hemodialysis three times a week is used in Tassin, France. Many observational studies and the prospective controlled London Study have suggested improvements in many intermediate patient outcomes such as dialysis-related symptoms, blood pressure and volume control, phosphate control (only for nocturnal daily dialysis), nutritional status, and quality of life. These studies are, however, too small and underpowered to evince differences in the primary outcomes, mortality and morbidity. An International Registry of Daily Dialysis has been created to obtain further information, and the US National Institutes of Health have sponsored two large-scale trials to compare short and nocturnal daily dialysis with conventional schemes. Organizational problems, higher costs especially initially, and the unavailability of simpler dialysis machines are the main factors that hamper the widespread use of these new schemes. Long nocturnal hemodialysis either in hospital or at home, three times a week or every other night, appears overall the best arrangement and the most attractive solution at present. It provides significant advantages with a minimal increase in cost. It would be interesting if the Italian National Health Service would prioritize funding for these promising schemes of hemodialysis.