Weekends Bad for Dialysis

In a new study of more than 36,000 patients who had participated in the ESRD [end-stage renal disease] Clinical Performance Measures Project, investigators found that on the day after the long weekend interdialytic interval, all cause mortality, cardiac mortality, vascular mortality, admissions for cardiovascular disease, as well as infection-related mortality were all significantly increased….

This increased mortality and morbidity appeared to be isolated to patients who had been on dialysis for more than a year, suggesting the role of residual kidney function in helping patients bridge the weekend gap. None of this is certain, by any means.

There is going to be push and there has already been discussion of whether dialysis schedules should be changed to be every other day or more frequently, or inserting an extra dialysis treatment somewhere up along the way. We have to be careful in noting that the study was not able to assess whether deaths or hospitalizations occurred before, during, or after the first of the week dialysis treatment, which would be important. The study was likewise not able to identify whether patients had missed the last of the previous week or first of the subsequent week’s dialysis treatment, which also would be important variables.

According Jeffrey Berns, University of Pennsylvania School of Medicine in Philadelphia, many questions still need to be answered, including whether patients need an extra treatment, or whether they need a longer treatment on Friday and Monday or Tuesday and Saturday, or whether they need an adjustment in the ultrafiltration rate or even in the dialysate composition. And before we jump in and make changes in our dialysis therapies on the basis of this retrospective study, we need to think about prospective studies that might be done to answer some of the questions and hypotheses that are raised by this study.

Foley RN, Gilbertson DT, Murray T, Collins AJ. Long interdialytic interval and mortality among patients receiving hemodialysis. N Engl J Med. 2011;365:1099-1107.