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Sudden and cardiac death rates in hemodialysis patients
A J Bleyer1, G B Russell, S G Satko
1Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. ableyer@wfubmc.edu
Insights
Sudden cardiac deaths are more common on Mondays and Tuesdays for hemodialysis patients. This weekly pattern, or septadian rhythm, is linked to the intermittent nature of hemodialysis treatments.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Sudden and cardiac death are frequent in hemodialysis patients.
- Hemodialysis's intermittent schedule may cause uneven death distribution weekly.
- Assessing the weekly pattern of sudden and cardiac death is crucial.
Purpose of the Study:
- To investigate the septadian rhythm of sudden and cardiac death in hemodialysis patients.
- To determine if hemodialysis influences the timing of cardiac events.
Main Methods:
- Utilized United States Renal Data System (USRDS) data from 1977-1997.
- Examined death dates for hemodialysis and peritoneal dialysis patients.
- Analyzed data from the USRDS Case Mix Adequacy Study.
Main Results:
- Peritoneal dialysis and non-cardiac hemodialysis deaths showed even weekly distribution.
- Hemodialysis patients had higher rates of sudden and cardiac death on Mondays and Tuesdays.
- Monday sudden deaths were 20.8% (P=0.002) and cardiac deaths 20.2% (P=0.0005) for M/W/F patients.
Conclusions:
- Hemodialysis's intermittent nature may increase sudden and cardiac death risk on Mondays and Tuesdays.
- Findings suggest a potential link between dialysis schedule and weekly cardiac event peaks.
- Further research into managing weekly cardiac risks in dialysis patients is warranted.
Background:
Sudden and cardiac death (including death from congestive heart failure, myocardial infarction, and sudden death) are common occurrences in hemodialysis patients. The intermittent nature of hemodialysis may lead to an uneven distribution of sudden and cardiac death throughout the week. The purpose of this study was to assess the septadian rhythm of sudden and cardiac death in hemodialysis patients.
Methods:
Data from the United States Renal Data System (USRDS) were obtained to examine the day of death for United States hemodialysis and peritoneal dialysis patients from 1977 through 1997. The days of death were also determined for patients in the Case Mix Adequacy Study of the USRDS.
Results:
There was an even distribution of sudden and cardiac deaths for patients on peritoneal dialysis, and hemodialysis patients dying of noncardiac deaths also had an even distribution. For all hemodialysis patients, Monday and Tuesday were the most common days of sudden and cardiac death. For patients in the Case Mix Adequacy Study designated as Monday, Wednesday, and Friday dialysis patients, 20.8% of sudden deaths occurred on Monday compared with the 14.3% expected (P = 0.002). Similarly, 20.2% of cardiac deaths occurred on Monday compared with the 14.3% expected (P = 0.0005). Similar trends were found on Tuesday for Tuesday, Thursday, and Saturday dialysis patients.
Conclusions:
The intermittent nature of hemodialysis may contribute to an increased sudden and cardiac death rate on Monday and Tuesday for patients enrolled in the USRDS.