The association between longer haemodialysis treatment times and hospitalization and mortality after the two-day break in individuals receiving three times a week haemodialysis

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>On the first haemodialysis (HD) day after the 2-day break in three times a week (3×W) in-centre HD, mortality and hospitalization are higher. If longer HD sessions prescribed 3×W is associated with a reduction in these events is unknown.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>HD session length in 19 557 prevalent European in-centre 3×W HD patients participating in the Dialysis Outcomes and Practice Patterns Study (1998–2011) were categorized into &amp;lt;200, 200–225, 226–250 or &amp;gt;250 min. Standardized event rates on the first (HD1) versus the second (HD2) HD day after the 2-day break, with supporting Cox proportional hazards models adjusted for patient and dialysis characteristics, were generated for all-cause mortality, all-cause hospitalization, out-of-hospital death and fluid overload hospitalization.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>By comparing HD1 with HD2, increased rates of all endpoints were observed (all P &amp;lt; 0.002). As HD session lengthened across the four groups, all-cause mortality per 100 patient-years on the HD1 (23.0, 20.4, 16.4 and 14.6) and HD2 (26.1, 13.3, 13.4 and 12.1) reduced. Similar improvements were observed for out-of-hospital death but were less marked for hospitalization endpoints. However, even patients dialysing &amp;gt;250 min were at significantly greater risk on HD1 when compared with their HD2 for out-of-hospital death [hazard ratio (HR) = 2.1, 95% CI 1.0–4.3], all-cause hospitalization (HR = 1.3, 95% CI 1.2–1.4) and fluid overload hospitalization (HR = 3.2, 95% CI 1.8–6.0).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Despite the association between reduced mortality across all dialysis days in patients performing longer sessions, elevated risk on the first dialysis day relative to the second persists even in patients dialysing 4.5 h 3×W.</jats:p> </jats:sec>

Emergency department visits and hospitalizations among hemodialysis patients by day of the week and dialysis schedule in the United States

“…We cannot say, however, the extent to which our findings may be generalizable to HD populations in other countries. Nevertheless, the study by Fotheringham et al [25], which was conducted in 7 European countries, yielded findings for all-cause hospitalization similar to ours: All three weekly patterns that we described are evident in their results (Fig 1B), though the authors focused attention on what we call the interdialytic-gap effect.…”

Variability and trends over time and across centres in haemodialysis weekly duration in Australia and New Zealand

“…Higher blood flow rate was more likely with longer hours on ICHD, whereas lower blood flood rate was associated with longer hours on HHD, which is expected in patients undergoing long hours/nocturnal HHD. Contrary to previous studies, 5,6,9,11 none of the evaluated comorbidities (diabetes mellitus, coronary artery disease, cerebrovascular disease, peripheral vascular disease and chronic lung disease) were found to be associated with treatment duration. It should be noted that various regression models were explored, but none showed a good model fit (low R ‐squared values), partly because of the limited nature of the data collected by the registry.…”

“…In a recent study by Swaminathan et al, 86 893 American patients were initiated on ICHD, of whom 55% were treated in 631 facilities (43% of all centres) with a uniform treatment time of 3 hours per session three times per week 10 . In Europe, Fotheringham et al reported about half (52%) of patients on thrice weekly ICHD being treated for approximately 4 hours (226‐250 minutes) per session in a cohort of 19 557 prevalent patients participating in the DOPPS from 1998 to 2011, while about 29% of patients were undergoing sessions of less than 4 hours 11 …”

“…In 1981, the National Cooperative Dialysis Study, aiming to develop a definition of adequate long‐term dialysis treatment by evaluating different concentrations of blood urea nitrogen (BUN) and treatment times, found that shorter treatment duration appeared to contribute to morbidity 1 . Since then, many observational studies have associated longer dialysis duration with lower mortality 2‐12 . Among these, a registry analysis from Australia and New Zealand in 2006 concluded that the optimal combination of haemodialysis treatment for better survival appeared to be Kt/V ≥ 1.3 and session length of ≥4.5 hours 6 .…”

Dialysis-Induced Cardiovascular and Multiorgan Morbidity

“…144 Longer and/or more frequent dialysis schedules are generally better tolerated and result in less circulatory stress compared to short dialysis schedules. 145,146 This reflects reduced solute gradients and fluxes, including electrolytes and ultrafiltration rate. 54 Importantly, fluid removal and solute and electrolytes fluxes are potentially modifiable factors of the dialysis prescription.…”