NDLI: Long interdialytic interval and mortality among patients receiving hemodialysis.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Collins, Allan J. Foley, Robert N. Gilbertson, David T. Murray, Thomas
Spatial Coverage	United States
Description	Author Affiliation: Foley RN ( United States Renal Data System, University of Minnesota, Minneapolis, MN 55404, USA.)
Abstract	BACKGROUND: Patients with end-stage renal disease requiring dialysis have limited tolerance of metabolic and volume-related deviations from normal ranges; in addition, the prevalence of cardiovascular disease is high among such patients. Given these problems, we hypothesized that a long interdialytic interval is associated with adverse events in patients receiving hemodialysis. METHODS: We studied 32,065 participants in the End-Stage Renal Disease Clinical Performance Measures Project, a nationally representative sample of U.S. patients receiving hemodialysis three times weekly, at the end of calendar years 2004 through 2007. We compared rates of death and cardiovascular-related hospital admissions on the day after the long (2-day) interdialytic interval with rates on other days. RESULTS: The mean age of the cohort was 62.2 years; 24.2% of the patients had been receiving dialysis treatment for 1 year or less. Over a mean follow-up interval of 2.2 years, the following event rates were higher on the day after the long interval than on other days: all-cause mortality (22.1 vs. 18.0 deaths per 100 person-years, P<0.001), mortality from cardiac causes (10.2 vs. 7.5, P<0.001), infection-related mortality (2.5 vs. 2.1, P = 0.007), mortality from cardiac arrest (1.3 vs. 1.0, P = 0.004), mortality from myocardial infarction (6.3 vs. 4.4, P<0.001), and admissions for myocardial infarction (6.3 vs. 3.9, P<0.001), congestive heart failure (29.9 vs. 16.9, P<0.001), stroke (4.7 vs. 3.1, P<0.001), dysrhythmia (20.9 vs. 11.0, P<0.001), and any cardiovascular event (44.2 vs. 19.7, P<0.001). CONCLUSIONS: The long (2-day) interdialytic interval is a time of heightened risk among patients receiving hemodialysis. (Funded by the National Institutes of Health.).
ISSN	00284793
Issue Number	12
Volume Number	365
e-ISSN	15334406
Journal	New England Journal of Medicine
Language	English
Publisher	Massachusetts Medical Society (United States)
Publisher Date	2011-09-22
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Kidney Failure, Chronic Mortality Therapy Renal Dialysis Adult Aged Cardiovascular Diseases Epidemiology Female Humans Male Middle Aged Adverse Effects Risk Time Factors United States Journal Article Research Support, N.I.H., Extramural Medicine
Content Type	Text
Resource Type	Article
Subject	Medicine

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