More Cardiovascular Events Occur After Longer HD Schedule
Cardiovascular events more than tripled 4 days following the last dialysis session.
CHICAGO—Patients on an unconventional hemodialysis (HD) schedule with a 3-day weekend in between sessions are more likely to experience cardiovascular events, according to a new study presented at the American Society of Nephrology's 2016 Kidney Week meeting.
Jalal E. Hakmei, MBChB, MD, Wayne R. Fitzgibbon, PhD, and Michael E. Ullian, MD, of the Medical University of South Carolina in Charleston, compared all-cause mortality and cardiovascular events among 29 HD patients with a short weekend hiatus between sessions (Mon-Wed-Fri or Mon-Tue-Fri) and 56 patients with a long weekend hiatus (Mon-Wed-Thu, Mon-Tue-Thu, Tue-Wed-Fri, and Tue-Thu-Fri) who attended their Veterans Affairs HD unit starting in 2002. Although the groups were similar, more patients in the short weekend group had coronary artery disease and elevated phosphorus levels.
Results showed no differences in death rate between groups, after adjustment for coronary artery disease and serum phosphorus level. A different picture emerged for cardiovascular events (CVEs), however. CVEs were expected to occur at the same rate on the day of dialysis and each of the 4 days following. Instead, in the short-weekend group, the investigators observed:
- 56% more CVEs than expected on the day of dialysis
- 52% fewer CVEs than expected the day following HD
- 22% fewer CVEs on the second day after HD
- 340% more CVEs on the third day following HD
In the long-weekend group, the investigators observed:
- 67% fewer CVEs on day 1
- 52% fewer CVEs on day 2
- 227% more CVEs on day 3
- 352% more CVEs on day 4
“In chronic HD patients, CVEs occur more frequently after longer inter-HD intervals,” Dr Hakmei and colleagues concluded. “Comorbidities like coronary artery disease and elevated phosphorus play a major role in prognosis of dialysis patients.”
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- Hakmei JE, Fitzgibbon WR, Ullian ME. Effect of Interdialytic Time on Outcomes in Chronic Hemodialysis Patients. Presented at: Kidney Week 2016. November 15-20, 2016. Chicago. Abstract TH-PO941.