Toxin and fluid removal are the main goals of dialysis therapy for patients with end-stage renal disease. Recent data indicate that the BUN-centered delivery of dialysis therapy with high efficiency, conventional, thrice-weekly hemodialysis therapy may fall short on the likewise critically important fluid control. Extended hour, in-center nocturnal HD (INHD) emerges as one of the alternative therapies for patients whose clinical needs are not met with conventional HD or who are seeking a dialysis therapy less interfering with daytime activities. We report the logistic requirements for a nocturnal program evaluated in a pilot at a midsize non-profit dialysis provider. In-center nocturnal hemodialysis provides longer dialysis sessions similar to the thrice-weekly 8-10 hour dialysis treatments originally prescribed in the early days of dialysis. INHD allows for a more flexible lifestyle-oriented dialysis schedule and enables patients to maintain routine daytime activities. It also offers an alternative schedule for patients who require extended-hour dialysis for various medical reasons.