Mortality Rises with Longer Intervals Between Dialysis Sessions

Hospitalizations for adverse cardiovascular events also were more common after 2-day interdialytic intervals.


In a small recent trial, patients with end-stage renal failure fared somewhat better with six-times-weekly than with thrice-weekly hemodialysis (JW Gen Med Jan 4 2011). Now, researchers have examined the effect of dialysis frequency by asking a different question: Are patients on thrice-weekly dialysis more likely to die after 2 full calendar days of no dialysis than after 1-day intervals? For example, are patients who receive dialysis on Monday, Wednesday, and Friday more likely to die on Mondays (after having no dialysis on Saturday and Sunday) than on other days?

In a cohort of 32,000 in-center hemodialysis patients, 41% died during average follow-up of 2.2 years. All-cause mortality was 23% higher on the day following a 2-day interdialytic interval than on the other 6 days of the week; about half the deaths resulted from cardiovascular causes. The analysis could not distinguish whether deaths on dialysis days occurred before, during, or after dialysis. Hospitalizations for adverse cardiovascular events were twice as likely after 2-day intervals than on other days.


Citation(s):

Foley RN et al. Long interdialytic interval and mortality among patients receiving hemodialysis. N Engl J Med 2011 Sep 22; 365:1099.