Three-Day Dialysis Isn't Enough

Dialysis patients have increased risk following a two day break

(RxWiki News) Most kidney failure patients get dialysis treatment three times a week, often taking off the weekend. These two-day breaks may not be such a good idea.

Patients who go two days between dialysis sessions have a higher risk of death and complications such as heart attack, stroke, and other heart-related problems.

"Do not go more than a day away from dialysis."

Patients with end-stage kidney disease (the complete or near complete failure of kidney function) who are on dialysis have a high risk of heart disease and other complications. In light of these problems, Robert N. Foley, M.B., from the University of Minnesota and the U.S. Renal Data System, and colleagues thought that taking long breaks between dialysis sessions may be associated with harmful events among dialysis patients.

""This is not a trial with random assignment to different treatment schedules," says Foley. "As a result, cause and effect relationships can't be proved. However this suggests that adding extra sessions that eliminate 2-day intervals could be beneficial. A large randomized trial would be needed to to prove this hypothesis."

They were right.

The researchers found that overall death rates were much higher on the day after a two-day break from a three-times-a-week dialysis treatment plan. Death rates from heart-related causes, cardiac arrest, heart attack, and infection were also elevated on the day after a two-day break from dialysis.

Patients who took off two days from dialysis were also more likely to be admitted to a hospital for heart attack, heart failure, stroke, dysrhythmia (a heart beat that is too fast, too slow, or irregular), or any heart-related event.

For their study, Foley and colleagues looked at 32,065 participants in the End-Stage Renal Disease Clinical Performance Measures Project, a nationally representative sample of American patients getting hemodialysis treatment three times per week. They compared the rates of death and heart-related hospital admissions on the day after the two-day break from dialysis to those rates on other days.

The researchers concluded that taking two days off of dialysis puts patients at risk.

According to Foley, "There is small but growing proportion of hemodialysis patients doing daily sessions, especially at home. This approach comes in many forms, including more days on treatment, with fewer hours per treatment. Smaller proof of concept trials suggest it may be a useful approach, but none has been large or long enough to be definitive."

This observational study is published in The New England Journal of Medicine. Support came from the National Institute of Diabetes and Digestive and Kidney Diseases. 

Review Date: 
September 22, 2011