Advantages and limitations of Long Nocturnal Hemodialysis (LNHD)




Long nocturna hemodialysis, ultrafiltration, quality of life, beta2-microglobulin, phosphatemy, mortality


Intermittent long nocturnal hemodialysis (LNHD) combines dialysis and sleep. Its clinical advantages are a reduced ultrafiltration rate, better control of blood volume with improved tolerance of the sessions and cardiac performance, better clearance of phosphates and middle molecules, and better survival in cohort studies. Quality of life is not impaired by the length of the sessions and, when not optimal, improves when transferring from standard hemodialysis (HD) to LNHD. The quality of sleep is sometimes disturbed, but it is not an important cause of exit from the program. The sustainability of an LNHD program depends on the joint medical and managerial will, the selection of stable patients, respect for schedules, and the duration of sessions, which is essential for sleep dialysis. The health authorities must play a role in allowing this modality under acceptable financial conditions. Informing the patient of the existence of LNHD before the dialysis stage is essential, helped by the testimony of peers. Learned societies should support research and the provision of information to nephrologists. Finally, architectural conditions that promote privacy and sleep are key to the success of the program.


Rocco MV, Lockridge RS, Jr., Beck GJ, Eggers PW, Gassman JJ, Greene T, Larive B, Chan CT, Chertow GM, Copland M et al: The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial. Kidney Int 2011, 80(10):1080-1091.

Chazot C, Ok E, Lacson E, Kerr PG, Jean G, Misra M: Thrice-weekly nocturnal hemodialysis: the overlooked alternative to improve patient outcomes. Nephrol Dial Transplant 2013, 28(10):2447-2455.

Huré F, Portanelli C: La montagne dans le sang. In.; 2021.

Jean G: Hemodialyse Longue Nocturne. In: 31ème symposium Gambro. 2010.

Lacson E, Jr., Xu J, Suri RS, Nesrallah G, Lindsay R, Garg AX, Lester K, Ofsthun N, Lazarus M, Hakim RM: Survival with three-times weekly in-center nocturnal versus conventional hemodialysis. J Am Soc Nephrol 2012, 23(4):687-695.

Flythe J, SE K, SM B: Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality Kidney Int 2011, 79:250-257.

Stefansson BV, Brunelli SM, Cabrera C, Rosenbaum D, Anum E, Ramakrishnan K, Jensen DE, Stalhammar NO: Intradialytic hypotension and risk of cardiovascular disease. Clin J Am Soc Nephrol 2014, 9(12):2124-2132.

Ok E, Duman S, Asci G, Tumuklu M, Onen Sertoz O, Kayikcioglu M, Toz H, Adam SM, Yilmaz M, Tonbul HZ et al: Comparison of 4- and 8-h dialysis sessions in thrice-weekly in-centre haemodialysis. Nephrol Dial Transplant 2011, 26:1287–1296.

Gutzwiller JP, Schneditz D, Huber AR, Schindler C, Gutzwiller F, Zehnder CE: Estimating phosphate removal in haemodialysis: an additional tool to quantify dialysis dose. Nephrol Dial Transplant 2002, 17(6):1037-1044.

Lacson E, Diaz-Buxo J: In-center nocturnal hemodialysis performed thrice-weekly--a provider's perspective. Semin Dial 2011, 24(6):668-673.

Karur GR, Wald R, Goldstein MB, Wald R, Jimenez-Juan L, Kiaii M, Leipsic J, Kirpalani A, Bello O, Barthur A et al: Association between conversion to in-center nocturnal hemodialysis and right ventricular remodeling. Nephrol Dial Transplant 2018, 33(6):1010-1016.

Cheung AK, Rocco MV, Yan G, Leypoldt JK, Levin NW, Greene T, Agodoa L, Bailey J, Beck GJ, Clark W et al: Serum beta-2 microglobulin levels predict mortality in dialysis patients: results of the HEMO study. J Am Soc Nephrol 2006, 17(2):546-555.

Chazot C, Kirchgessner J, Pham J, Vo-Van C, Lorriaux C, Hurot JM, Zaoui E, Grassmann A, Jean G, Marcelli D: Effect of Membrane Permeability on Cardiovascular Risk Factors and beta2m Plasma Levels in Patients on Long-Term Haemodialysis: A Randomised Crossover Trial. Nephron 2015, 129(4):269-275.

Eloot S, Van Biesen W, Dhondt A, Van de Wynkele H, Glorieux G, Verdonck P, Vanholder R: Impact of hemodialysis duration on the removal of uremic retention solutes. Kidney Int 2008, 73(6):765-770

Maduell F, Arias M, Duran CE, Vera M, Fontsere N, Azqueta M, Rico N, Perez N, Sentis A, Elena M et al: Nocturnal, every-other-day, online haemodiafiltration: an effective therapeutic alternative. Nephrol Dial Transplant 2012, 27(4):1619-1631.

Laruelle E, Corlu L, Pladys A, Dolley Hitze T, Couchoud C, Vigneau C: [Prolonged hemodialysis: Rationale, practical organization, results]. Nephrol Ther 2021, 17S:S71-S77.

Dumaine CS, Ravani P, Parmar MK, Leung KCW, MacRae JM: In-center nocturnal hemodialysis improves health-related quality of life for patients with end-stage renal disease. J Nephrol 2022, 35(1):245-253.

Hull KL, Quann N, Glover S, Wimbury C, Churchward DR, Pickering WP, Preston R, Baines R, Graham-Brown MPM, Burton JO: Evaluating the clinical experience of a regional in-center nocturnal hemodialysis program: The patient and staff perspective. Hemodial Int 2021, 25(4):447-456.

Li JW, Wong JHS, Chak WL, Chau KF: Effect of incident nocturnal home hemodialysis versus incident continuous ambulatory peritoneal dialysis on employment rate, clinical, and laboratory outcomes: A 1-year retrospective observation study. Hemodial Int 2018, 22(3):308-317.

Rivara MB, Adams SV, Kuttykrishnan S, Kalantar-Zadeh K, Arah OA, Cheung AK, Katz R, Molnar MZ, Ravel V, Soohoo M et al: Extended-hours hemodialysis is associated with lower mortality risk in patients with end-stage renal disease. Kidney Int 2016, 90(6):1312-1320.

Jansz TT, Noordzij M, Kramer A, Laruelle E, Couchoud C, Collart F, Cases A, Arici M, Helve J, Waldum-Grevbo B et al: Survival of patients treated with extended-hours haemodialysis in Europe: an analysis of the ERA-EDTA Registry. Nephrol Dial Transplant 2020, 35(3):488-495.

Henderson LW: Symptomatic Intradialytic Hypotension and Mortality: An Opinionated Review. Semin Dial 2012, 25(3):320-325.



How to Cite

Chazot C, Jean G. Advantages and limitations of Long Nocturnal Hemodialysis (LNHD). Bull Dial Domic [Internet]. 2022 Sep. 6 [cited 2024 Jun. 13];5(3):223-32. Available from:



Home dialysis day (DIADOM) of Universitary Seminars of Nephrology , Paris 2022