Home HD in Australia is practiced without remote monitoring, although most units will maintain an on-call service for patients via both nursing and medical staff, as well as machine technicians if needed. Some centres internationally mandate remote monitoring for home HD with the benefits of documenting PLX4032 adherence to treatment regimens, providing patient reassurance and allowing for data collection to study physiological effects of NHD. Additional safety precautions for patients undertaking alternative HD regimes, especially NHD at home, include securing of blood lines, floor moisture sensors that may aid in detection of blood or dialysate

leaks and the taping of a moisture sensor (such as an enuresis alarm or newly developed sensor patch) close to the AVF needle sites may allow the patient to recognize early needle dislodgement. There is limited literature

comparing parameters for patients undertaking different NHD schedules, either alternate-night (3.5 nights per week) or more frequent NHD (5–7 nights BGJ398 molecular weight per week). One Australian study (n = 34) compared biochemical and volume parameters between these regimens and reported significantly lower urea and creatinine levels (pre- and post-HD), higher calcium levels, reduced ultrafiltration rates and intradialytic weight gains in those undertaking the more frequent NHD regimen.41 In this study, 38% of patients doing alternate-night NHD still required phosphate binders compared with none in the more frequent group. The study concluded Glutamate dehydrogenase that NHD performed 5–7 nights per week offered optimum biochemical and volume outcomes, but alternate-night NHD may have additional appeal related to cost advantages with reduced consumable expenditure. A flexible dialysis programme should therefore offer varying time and frequency options for home HD patients to be sympathetic to the clinical rehabilitation and lifestyle aspirations of the individuals on dialysis. One further Australian study also assessing the control of biochemical

parameters in NHD patients receiving alternate-night HD (n = 26) showed that after conversion from conventional HD there was improvement in parameters of bone and mineral metabolism as well as reduction in vascular calcification.49 Alternate-night NHD is therefore effective and offers lifestyle advantages for patients compared with more frequent NHD and, although not as efficient as 5–7 nights per week, it may be that alternate-night is potentially more cost-effective. Alternative HD regimens like SDHD and NHD allow for increased flexibility in dialysis treatments and are associated with significant physiological and quality of life improvements when compared with conventional HD, although survival benefits are as yet unproven. Although larger studies are required to confirm benefits, there is an increasing interest in using these schedules.