Importance of treatment time and blood pressure control in achieving long-term survival on dialysis

A drastic reduction in hemodialysis (HD) time has been based on the dialysis dose measurement in terms of urea Kt/V exclusively and on the use of high efficiency dialysers. It was subtly coupled to a de-emphasis of the use of HD to normalize blood pressure. In Tassin we have maintained long slow HD with an overall excellent patient survival. We analyze the influence of the different factors of this survival: the place of dry weight and blood pressure control without use of antihypertensive medication is emphasized, and the role of dialysis dose and nutrition is discussed. Adequacy should be defined in terms of these additive conditions. Long slow HD allows one to fulfill these conditions easily. Shortening of dialysis time should not interfere with the control of blood pressure.