My Suggested Fix: Home Single Needle Hemodialysis 3x a week. Combined with Self care. 1. Self care: I know Fresenius is working (slowly) on self care dialysis. Understandably, as a large corporate entity they have check with legal on this. I wish they were working faster on this. This will grow the confidence of dialysis patients from day one. They would no longer think they are helpless and need completely rely upon techs and nurses. If Fresenius builds strongly upon this DaVita no doubt will also. 2. New technology: FMC will begin clinical trials on their new home hemo machine. I hope to have hands on soon. From what I hear is that it can be used three days a week in-center and and short daily. My hope is that it can be used 4 nights a week nocturnal at home. But with the sorbent technology that it utilizes they might need to create an extra-large dialysate filter. 3. Self-care to home nocturnal: this should be pretty easy if the patient has already learned in-center how to cannulate. 4 or 4+ night nocturnal would vastly improve nearly all metrics: feel better, improved Hgb with less EPO, fewer or no bp meds, lower phosphorus with fewer binders, less time burden, fewer dialysis clinics and easier to build stand alones for PD and home hemo. 4. Other thoughts and ideas: I would love a single needle device that would have both arterial and venous blood. This would eliminate any chance of un-noticed needle removal. There are devices that sense accidental needle removal but a single needle would essentially eliminate user error. A huge issue with a lot of in-center patients is that they don't want to improve their lives because they don't believe they can do their own dialysis. We must teach them from day one that they can own their care.