Reflecting on 14 Years of Nocturnal Home Hemodialysis in Canada (1990S‪)‬

On April 19, 1994, the first of six patients participating in a demonstration project sponsored by the Ontario Ministry of Health was discharged to perform nocturnal home hemodialysis (NHHD) six nights per week. At the time, no one realized just how crucial a role this demonstration project would play in advancing renal therapy for dialysis patients in Canada and around the world. The late Dr. Robert Uldall, a nephrologist first at the Toronto Western Hospital and then at the Wellesley Hospital in Toronto, was the visionary behind what we now call nocturnal hemodialysis. He believed that if dialysis patients could receive more frequent hemodialysis over a longer period of time, their quality of life would be significantly enhanced and their disease burden reduced. Dr. Uldall sent these six patients home with a prescription for eight hours of dialysis six nights per week while they slept. They used the 2008H hemodialysis machine (Fresenius Medical Care, Waltham, Massachusetts, U.S.) and reprocessed F40 polysulfone high flux dialyzers (0.7 [m.sup.2]) (Fresenius Medical Care, Waltham, MA) with blood flows of 300 ml/min and dialysate flows of 100 ml/min via the Uldall Cook catheter (Cook Group Incorporated, Bloomington, Indiana, U.S.). The acid concentrate prescribed was a 2.0 mmol/L of potassium and 1.25 mmol/L of calcium. Treatment parameters and alarm conditions were remotely monitored over telephone lines using FDS08 software (Fresenius Medical Care, Waltham, MA) from a central location in the training centre at the Wellesley Hospital. How has the therapy evolved?