Background
Patients with end-stage renal disease requiring dialysis have limited tolerance of metabolic and volume-related deviations from normal ranges; in addition, the prevalence of cardiovascular disease is high among such patients. Given these problems, we hypothesized that a long interdialytic interval is associated with adverse events in patients receiving hemodialysis.
Methods
We studied 32,065 participants in the End-Stage Renal Disease Clinical Performance Measures Project, a nationally representative sample of U.S. patients receiving hemodialysis three times weekly, at the end of calendar years 2004 through 2007. We compared rates of death and cardiovascular-related hospital admissions on the day after the long (2-day) interdialytic interval with rates on other days.
Results
The mean age of the cohort was 62.2 years; 24.2% of the patients had been receiving dialysis treatment for 1 year or less. Over a mean follow-up interval of 2.2 years, the following event rates were higher on the day after the long interval than on other days: all-cause mortality (22.1 vs. 18.0 deaths per 100 person-years, P<0.001), mortality from cardiac causes (10.2 vs. 7.5, P<0.001), infection-related mortality (2.5 vs. 2.1, P=0.007), mortality from cardiac arrest (1.3 vs. 1.0, P=0.004), mortality from myocardial infarction (6.3 vs. 4.4, P<0.001), and admissions for myocardial infarction (6.3 vs. 3.9, P<0.001), congestive heart failure (29.9 vs. 16.9, P<0.001), stroke (4.7 vs. 3.1, P<0.001), dysrhythmia (20.9 vs. 11.0, P<0.001), and any cardiovascular event (44.2 vs. 19.7, P<0.001).
Conclusions
The long (2-day) interdialytic interval is a time of heightened risk among patients receiving hemodialysis. (Funded by the National Institutes of Health.)
Supported by a contract (HHSN267200715002C) from the National Institute of Diabetes and Digestive and Kidney Diseases.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
We thank United States Renal Data System colleagues Beth Forrest for regulatory assistance and Shane Nygaard for assistance with manuscript preparation, and Nan Booth, M.S.W., M.P.H., for editorial assistance with an earlier version of the manuscript.
Source Information
From the United States Renal Data System (R.N.F., D.T.G., T.M., A.J.C.) and the University of Minnesota (R.N.F., T.M., A.J.C.) — both in Minneapolis.
Address reprint requests to Dr. Foley at the United States Renal Data System, 914 S. 8th St., Suite S-406, Minneapolis, MN 55404, or at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
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