Hospitalization and mortality following non-attendance for hemodialysis according to dialysis day of the week: a European cohort study

BMC Nephrology, vol. 21, pp. 218

Abstract

BACKGROUND: The extension of the interdialytic interval due to due to dialysis session non-attendance varies according to which session of the week the patient misses. The impact of this on subsequent hospitalization and mortality is unknown. METHODS: The ARO cohort study prospectively collected data from hemodialysis patients across 15 European countries on demography, comorbidity, laboratory, hospitalisation, mortality and individual hemodialysis sessions from 2007 to 2014. Event rates for death and hospitalisation according to dialysis day of the week were calculated for patients who attended the three previous scheduled hemodialysis sessions, who then on the next scheduled dialysis day either attended or did not attend. The hazard ratio for these events following non-attendance for the first compared to the second dialysis session of the week was estimated using Cox proportional hazards model adjusted for patient demographics. RESULTS: 3.8 million hemodialysis sessions in 9397 patients were analysed. The non-attendance rates for Monday/Wednesday/Friday sessions were 0.8, 0.9% & 1.4% respectively, and for Tuesday/Thursday/Saturday sessions were 0.6, 1.0% & 1.2% respectively. Compared to those who attended, for the 48-72 h between non-attendance and the next scheduled haemodialysis session, mortality significantly increased from 4.86 to 51.9/100 pt-yrs and hospitalisation increased from 0.58 to 2.1/yr. As time from the two-day break increased, the risk associated with non-attendance lessened: compared to missing the second hemodialysis session, missing the first session had a hazard ratio for mortality of 2.04 (95% CI 1.27-3.29), and for hospitalisation 1.78 (95% CI 1.29-2.47). In patients who attended their scheduled dialysis session and the three preceding, after the two-day break there were absolute increases in mortality (8.3 vs. 4.9/100 pt-yrs) and hospitalisation (1.0 vs. 0.6/yr for the rest of the week) comparable to previous studies. CONCLUSIONS: In addition to hospitalisation and mortality increases seen after the two-day break, additional harm may be manifested in the greater increases in mortality and hospitalisation observed after non-attendance for the first hemodialysis session after the two-day break compared to missing other sessions.

Authors 8

1. James Fotheringham corresponding

   University of Sheffield · Sheffield Kidney Institute · Northern General Hospital

   Affiliation as printed

   Northern General Hospital, Sheffield Kidney Institute, Herries Road, Sheffield, South Yorkshire, S5 7AU, UK. j.fotheringham@sheffield.ac.uk

   School of Health and Related Research, University of Sheffield, Sheffield, UK. j.fotheringham@sheffield.ac.uk

   Northern General Hospital, Sheffield Kidney Institute, Herries Road, Sheffield, South Yorkshire, S5 7AU, UK

2. Michael Thomas Smith

   University of Sheffield

   Affiliation as printed

   Computer Science, University of Sheffield, Sheffield, UK

3. Marc Froissart

   Centre Hospitalier Universitaire Vaudois

   Affiliation as printed

   Clinical Trial Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

4. Florian Kronenberg

   Innsbruck Medical University · Universität Innsbruck

   Affiliation as printed

   Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria

5. Peter Stenvinkel

   Karolinska University Hospital

   Affiliation as printed

   Department of Renal Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden

6. Jürgen Floege Aachen Department of Nephrology

   RWTH Aachen University

   Affiliation as printed

   Department of Nephrology, RWTH University of Aachen, Aachen, Germany

7. Kai‐Uwe Eckardt

   Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin-Berlin, Berlin, Germany

   Department of Nephrology and Medical Intensive Care, Charité – Universitätsmedizin-Berlin, Berlin, Germany

8. David Collins. Wheeler

   University College London

   Affiliation as printed

   Department of Renal Medicine, University College London, London, UK