To the Editor:

We would like to offer an Australian response to Cahill's question "Is a change in adequacy standards necessary?" (Cahill, 2007). Our answer is an overwhelming "yes." Our Australian experience has shown that innovative therapies such as nocturnal home hemodialysis (NHHD) and short daily hemodialysis (sDHD) offer superior 'adequacy,' allow more patients to dialyze independently, and free up valuable incenter spaces. The evidence that flexible regimes such as NHHD and sDHD are superior treatments is mounting with lower mortality (Blagg, 2005) and improved observational outcomes (Agar, 2007; Culleton et al., 2007; Saran et al., 2006).

Furthermore, many ...