Issue 150 Item 7 Morning and Evening Dialysis Sessions Linked to Improved Surviv

Patients who undergo hemodialysis in the morning or evening have better survival rates than those who undergo dialysis in the afternoon. That, according to a report published in the April issue of the American Journal of Kidney Diseases.

“Because of our large sample size, we were also able to look at the effect of evening shift dialysis on survival,” he said. Similar to the morning shift findings, survival was improved for patients dialyzed in the evening versus the afternoon.

The findings are based on a study of nearly 7000 patients with renal failure who began hemodialysis between 1990 and 1993 and were entered into a national registry. Survival data were analyzed based on the time of day dialysis was performed: morning shift (5 am to 12 pm), afternoon shift (12 pm to 6 pm), or evening shift (6 pm to 12 am).

The 4-year survival rates for patients who underwent morning, afternoon, and evening shift dialysis were 28.8%, 24.1%, and 38.7%, respectively. On multivariate analysis, morning and evening sessions were associated with significantly lower mortality rates than afternoon sessions.

The researchers found that the effect of dialysis time on survival was limited to patients who were 60 years of age or older.

“In terms of a real mechanism for why morning shift dialysis may be beneficial, the authors of the previous study speculated that it may be due to better sleep during morning sessions,” Dr. Abbott said. “My own bias, however, is that if there is a true benefit it is more related to effects on cardiovascular function than on sleep patterns.” Am J Kidney Dis 2003;41:796-806.