In the United States, maintenance hemodialysis (HD) is typically prescribed as thrice-weekly treatments with two 1-day and one 2-day intervening intervals between dialysis sessions.1,2 However, given the impaired ability of HD patients to excrete electrolytes, fluid, and uremic solutes and their high prevalence of cardiovascular disease (eg, structural heart disease and subclinical ischemia), these patients may have limited reserve to tolerate the deviations in metabolic and volume status associated with the long 2-day interdialytic interval.