When kidney function is lost to a certain extent, the toxins and water produced by the body’s metabolism cannot be removed effectively in time, they will accumulate in the body and cause a variety of adverse manifestations, including nausea and vomiting and elevated blood pressure. When medication is ineffective, dialysis treatment is required. Normal kidneys work every second of the day, while hemodialysis can only be performed a few times a week. The most common current standard dialysis protocol is to dialyze three times a week for four hours each time, or 12 hours a week. After dialysis, toxins drop to near normal levels and water is adequately removed. a dialysis interval of about 50 hours is followed by the next dialysis session, or longer if dialysis is performed twice a week. During the dialysis interval, toxin levels gradually increase, water is gradually retained, and blood pressure gradually rises. Therefore, although hemodialysis is the most successful of the current organ replacement therapies, the intermittent nature of hemodialysis treatment poses many problems compared to healthy kidneys, such as difficulty in controlling blood pressure due to water retention between dialysis sessions, high dosage of erythropoietin, impaired heart structure and function, and susceptibility to infection. Many years ago it was hypothesized that if the total number of dialysis hours per week was increased by increasing the frequency of dialysis, it might improve the symptoms, reduce the drug dosage, and improve the quality of life of hemodialysis patients. In recent years, several papers have been published in leading foreign journals affirming the good results of extended hemodialysis duration. These studies have found that extended dialysis can significantly improve appetite and nutritional status, improve activity tolerance and become more energetic, improve cardiac function, make hyperphosphatemia easier to control, and reduce the use of antihypertensive drugs and erythropoietin. However, no definitive answer can be given internationally as to how long dialysis is optimal. An open global multicenter randomized controlled trial, known as the ACTIVE D study, was initiated by the George Medical Research Centre in Australia and supported by funds from the Australian government. The aim of the study is to compare the effects of an extended dialysis regimen and a standard dialysis regimen on quality of life on dialysis and cardiac structure in hemodialysis patients. The study is preparing to enroll 240 patients and is already being conducted in Australia, New Zealand and Canada. Our country has also joined the study and is preparing to recruit 120 hemodialysis patients in 20 hemodialysis units. The 20 study sites across the country will have the same recruitment criteria for patients (18 years of age or older, male or female; currently on hemodialysis and no plans to have a kidney transplant or change to peritoneal dialysis within 1 year). 120 patients will be randomly assigned to the extended dialysis group and the standard dialysis group (not optional for the patients themselves), with the extended dialysis group dialyzing 4 times a week for 6 hours each time or 5 times a week for at least 4.8 hours each time. The observation period was 1 year. Based on observations of patients who have entered the study in China, patients in the extended dialysis group showed improved nutrition, weight gain, easier control of blood phosphorus, and reduced dosage of erythropoietin and antihypertensive medications, with more detailed analyses to be published after the study is completed. The ACTIVE D study must have been more costly than standard dialysis because of the extended dialysis time and the consumption of more dialysis supplies and labor. During the course of the study, the additional costs associated with extended dialysis were supported by Australian government funds, so that extended dialysis could be carried out successfully. Since the benefits of extended dialysis have been demonstrated in published studies abroad, and initial observations of our patients in the ACTIVE D study confirm the benefits of extended dialysis, it is theoretically correct to apply it to hemodialysis patients. However, given the increased cost of this dialysis regimen, extended dialysis is more cost-effective when applied to patients with indications for (1) difficult-to-control hypertension, (2) difficult-to-control hyperphosphatemia, (3) advanced age, (4) low or high blood pressure during dialysis, (5) high volume load and severe edema, (6) pro Erythropoietin dosage is high and the cause is unknown. Please consult your doctor if you or your friend or family member is suitable for extended dialysis. Return to the standard dialysis regimen when the above conditions improve. Although extended dialysis consumes more medical resources and is more costly, correspondingly, the near-term costs (e.g., less medication) and long-term costs (e.g., fewer heart attacks) are greatly reduced due to benefits such as relief of various symptoms, reduction in long-term heart disease, and reduction in medication dosage, resulting in an overall reduction in the consumption of medical resources. Whether the overall cost of patient management is ultimately higher or lower as a result of prolonged dialysis remains to be answered by a careful analysis of the data after the study is completed.