Hospitalization and mortality following nonattendance of a scheduled thrice-weekly maintenance hemodialysis (HD) session differs depending on the dialysis day of the week. Risks appear greatest when the first session is missed after the long interdialytic interval, a new study finds.

In the study of 9397 patients who received 3.8 million HD sessions at Fresenius facilities in 15 European countries, nonattendance of a session was significantly associated with increased mortality (51.9 vs 4.86 per 100 patient-years) and hospitalization (2.1 vs 0.58 per year) in the 48 to 72 hours afterward, compared with attendance, James Fotheringham, MD, of the Sheffield Kidney Institute, Northern General Hospital in the United Kingdom, and colleagues reported in BMC Nephrology.

Missing the first dialysis session (Monday or Tuesday) after the 2-day break was associated with greater mortality (2.04 vs 0.71) and hospitalization (1.78 vs 0.92) risks than missing a midweek session with a 1-day break.

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As shown in previous studies, patients with full attendance to their thrice-weekly dialysis schedule also have higher absolute rates of mortality (8.3 vs 4.9 per 100 patient-years) and hospitalization (1.0 vs 0.6 per year) after the long interdialytic interval compared with another dialysis day of the week.

“There is mounting evidence of the size and mechanism of harm from the two-day break in three times a week dialysis,” Dr Fotheringham’s team discussed. “We were able to use session-level data…to show that this harm expands to the period immediately after non-attendance with greater increases in hospitalization and mortality after the long interdialytic interval.”

The investigators encouraged health care providers to counsel patients on the potential harms of missing dialysis sessions, especially after the long interdialytic interval.

Disclosure: This clinical trial was supported by Amgen. Please see the original reference for a full list of authors’ disclosures.


Fotheringham J, Smith MT, Froissart M, et al. Hospitalization and mortality following non-attendance for hemodialysis according to dialysis day of the week: a European cohort study [published online June 9, 2020]. BMC Nephrol 21;218. doi: 10.1186/s12882-020-01874-x