More Frequent In-Center Hemodialysis in Pediatric End Stage Renal Disease

Inclusion Criteria: * Current outpatient ESRD pediatric patients, 3-21 years old, receiving in-center chronic HD. * Patients have to be on chronic HD for at least 2 months before eligibility Exclusion Criteria: * Patients with a scheduled (with a specific transplant date) kidney transplant in the next 6 months * Patients scheduled to be switched to peritoneal dialysis in the next 6 months * Patients currently receiving \>3 days per week of hemodialysis * Patients currently receiving \>12 hours per week of hemodialysis * Anyone \<3 years of age would be excluded from the study, so our minimum anticipated patient weight would be about 11 kg * Patients \>21 years of age at enrollment * Patients receiving concomitant peritoneal dialysis * Patients with \<2 months on chronic HD * Patients with a temporary or femoral dialysis catheter * Patients who are not hypertensive (both not on blood pressure medication and with a SBP \<95th percentile for age, sex, and height) * Patients enrolled in an investigational drug trial involving blood pressure medication or any other clinical trial potentially affecting the primary outcome of the study Patients listed for a deceased donor transplant will not be excluded.