By Todor Metchkov
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Bacterial products are thought to be responsible for some long-term complications of dialysis. Accordingly, Shaldon and Koch  stated that ultrapure dialysate was every bit at least as important as the biocompatibility of the membrane. The system of Tersteegen provides ideal hygienic properties because several factors could be combined in its design: Ultrapure water: This is essential to produce sterile and pyrogen-free dialysate. 98 Kidney Blood Press Res 2003;26:96–99 The Clinical Experience If one believes in the importance of ultrapure dialysate, of individualized dialysate electrolyte composition and of ultrafiltration control, one will not be surprised to see that in the uncontrolled series of Kleophas et al.
Phosphate/Bone Disease Phosphate control improves on short daily HD. Although there is no good documentation in the literature , a lower dose of phosphate binders has been reported by Kooistra et al. . Short daily dialysis did not lead to discontinuation of phosphate binders. In our center we could demonstrate in 2 patients a marked improvement of phosphate control even after switching from 3 ! 8 h to 6 ! 3 h dialysis regimen. Kidney Blood Press Res 2003;26:90–95 93 Anemia Nearly all studies on short daily HD found a decrease in the erythropoietin dose of 30–50% [9, 14, 17].
Weekly dialysis treatment time with this method is comparable to standard dialysis. By using computer simulation, Gotch  and Clark et al.  calculated that short daily dialysis for 100 min 7 times weekly (700 min/week) provides 5% better equivalent renal urea clearance and 12% greater vitamin B12 clearance than a conventional regimen of 4 h 3 times weekly (720 min/ week). Both non-protein-bound uremic compounds such as uric acid, creatinine and urea and some protein-bound solutes such as indole-3-acetic acid, indoxyl sulfate and p-cresol were lower during short daily HD .