WEDNESDAY, Sept. 21 (HealthDay News) -- Waiting more than a day
between dialysis treatments ups the risk of death and
hospitalization in people with kidney disease, new research
Patients are more likely to die or head to the hospital for
cardiovascular-related and other complications following a two-day
interval between dialysis sessions compared to a one-day gap,
concluded researchers from the U.S. Renal Data System (USRDS) and
the University of Minnesota, both in Minneapolis.
"It shows an association between adverse outcomes and a two-day interval between dialysis sessions," said study author Dr. Robert Foley, deputy director of the USRDS Coordinating Center, whose observational study involved more than 32,000 people on hemodialysis.
Hemodialysis is the more common form of dialysis in the United
States, said Dr. Martin Zand, a professor of medicine in the
division of nephrology at the University of Rochester Medical
Center in New York. Used by people whose kidneys function at about
15 percent or less, this machine-based treatment removes toxins and
extra fluid from the blood. Zand said kidney failure patients
typically visit an outpatient dialysis center three times a week
for sessions that last roughly four hours.
"Most patients are on a Monday, Wednesday, Friday schedule, or a Tuesday, Thursday, Saturday schedule, so once a week, they're missing dialysis for two days instead of one," Zand explained.
More than 340,000 people with chronic kidney disease are on
hemodialysis, according to the U.S. National Kidney Foundation. In
75 percent of cases, kidney failure is caused by diabetes and high
The study, published in the Sept. 22 issue of the
New England Journal of Medicine, followed 32,065 dialysis patients, average age 62, for a little more than two years.
During that time, 41 percent died from all causes. The average
annual death rates were 22 percent on the day after the two-day
interval compared to 18 percent on other days. The findings showed
cardiac-related death rates were higher after the two-day interval,
10.2 percent compared to 7.5 percent after a one-day gap. Cardiac
arrest after the longer interval was 1.3 percent compared to 1
percent, and deaths from heart attack were 6.3 percent vs. 4.4
Hospital admission rates were also steeper following the longer
wait between dialysis visits. Hospitalization rates for heart
attack were 6.3 percent compared to 3.9 percent, and congestive
heart failure admission rates were almost double after a two-day
interval (29.9 percent vs. 16.9 percent). Hospitalization rates for
stroke were also higher (4.7 percent vs. 3.1 percent).
"This is a terrific study. Well-designed and clearly written," said Dr. Ajay Singh, an associate professor of medicine at Harvard Medical School and a practicing nephrologist. While the authors do not discuss the potential explanation for their findings, Singh said it's possible that the higher risk of death and hospitalization associated with the longer wait time stems from excessive fluid buildup or an electrolyte abnormality, perhaps related to elevated potassium levels, that harm the heart. Potassium is a mineral that can build up in blood and cause an abnormal heartbeat called an arrhythmia.
"The take-away message of the study is really something that many of us have known from our clinical practices for years -- that the long two-day interval between dialysis treatments in somebody on a three-day-a-week schedule is a point of high risk for heart attacks, congestive heart failure and hospital admissions," Zand said. "It begs the question, do we need to re-examine the three-day-a-week schedule?"
Foley said it's too early to change dialysis protocol. "Our
study suggests that alternate-day treatment versus conventional
three times per week treatment is a trial that needs to be
seriously considered," he said.
Foley also emphasized that studies like this that draw
conclusions from associations "are shaky foundations" upon which to
build new treatment guidelines. He said the next step should be a
trial in which patients are randomly assigned to different dialysis
schedules and their outcomes compared.
Zand said concerned patients might want to explore other
dialysis options with their physicians, including daily home
peritoneal dialysis or night-time outpatient hemodialysis, which
could add additional blood-cleansing hours. He said they can also
discuss taking extra steps to reduce the risk of complications on
the two-day stretches between dialysis stints by minimizing fluid
intake, salty foods and high-potassium foods, such as avocados and
Find out more about kidney dialysis at the
U.S. National Kidney Foundation.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.