Longer recovery times after a hemodialysis session are associated with an increased risk of hospitalization and death, according to a new study.

Hugh C. Rayner, MD, of Birmingham Heartlands Hospital in Birmingham, U.K., and colleagues studied 6,040 patients receiving HD in the Dialysis Outcomes and Practice Patterns Study (DOPPS). They analyzed patient responses to the following question: “How long does it take you to recover from a dialysis session?” The median follow-up was 16 months.

The researchers found that 32% of patients reported a recovery time shorter than 2 hours, 41%, 2-6 hours; 17%, 7-12 hours; and 10% longer than 12 hours.

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The researchers recorded hospitalization events for 3,119 patients (52%); 826 patients (14%) died. Compared with patients with reported recovery times of 2-6 hours, patients with a reported recovery time of more than 12 hours had a 16% increased risk of a first hospitalization and 30% increased risk of death in adjusted analyses, Dr. Rayner’s group reported online ahead of print in the American Journal of Kidney Diseases.

After adjusting for demographic and comorbid factors, each additional hour of recovery time was associated with a 3% increased risk of a first hospitalization and a 5% increased risk of death from any cause.

Longer recovery time was associated with older age, female gender, dialysis vintage, body mass index, diabetes, and psychiatric disorders, as well as greater intradialytic weight loss, longer dialysis session length, and lower dialysate sodium concentration.

In adjusted analyses, each 1% increase in intradialytic weight loss was associated with a 4% increased risk of a patient reporting a longer recovery time (for example, less than 2 hours vs. 2 or more hours, 6 hours or less vs. 7 hours or more, and so on).

Compared with a dialysate sodium concentration of 140 mEq/L, a lower concentration was associated with a 34% increased risk. Each 30-minute increase in dialysis session length was associated with a 5% increased risk. Patients with a psychiatric disorder had 39% increased risk of reporting longer recovery time than those without a psychiatric disorder.

“Recovery time has a significant impact on patients and may be affected by modifiable aspects of the treatment regimen,” the authors wrote. “Hence, the recovery time question potentially could be used as an audit measure of the quality of hemodialysis treatment.”

With respect to study limitations, the researchers pointed out that answers to the recovery time question are subjective and not supported by physiologic measurements.