Date Published: July 10, 2017
Publisher: Public Library of Science
Author(s): Masataka Banshodani, Hideki Kawanishi, Shingo Fukuma, Misaki Moriishi, Sadanori Shintaku, Shinichiro Tsuchiya, Tatsuo Shimosawa.
There have been no studies as yet that have evaluated how hemodialysis (HD) schedules affect the day of the week of hospitalization for cardiovascular diseases (CVDs) and infectious diseases (IDs), over a period of time. Herein, we performed a retrospective observational cohort study (1995–2014) evaluating 11,111 hospitalizations in 1,953 patients with end-stage renal disease, receiving HD 3 times a week (following either a Monday-Wednesday-Friday [MWF] schedule or a Tuesday-Thursday-Saturday [TTS] schedule) or receiving frequent HD (FHD) at least 4 times a week. Overall, hospitalization rates for CVDs and IDs were the highest on Monday in the MWF schedule and Tuesday in the TTS schedule compared to the average rates for all the days of the week. When generalized estimating equations (GEEs) were used in conjunction with robust variance estimators of each type of CVD, the risk for pulmonary edema was found to be significantly higher on Sunday and Monday in the MWF schedule and Monday and Tuesday in the TTS schedule. For both cerebrovascular and ischemic heart disease, the risks were significantly higher on Tuesday in the MWF schedule and Wednesday in the TTS schedule. Moreover, there were significant differences in the day of the week risks among the various CVD types. On trend analysis, the overall hospitalization rate for CVDs on the first HD day did not decrease (P = 0.2); however, the hospitalization rate for IDs on the first HD day significantly decreased (P = 0.02) over a span of 20 years. When GEEs were used in the case of FHD patients with severe heart failure, the hospitalization rate on the first HD day (Monday) significantly decreased after FHD initiation (P = 0.04). It was found that HD schedules affected the day of the week of hospitalization for CVDs. FHD may lower the day of the week risk.
End-stage renal disease (ESRD) is associated with increased mortality and the risk of acquiring cardiovascular diseases (CVDs) . In addition, the intermittency of hemodialysis (HD), which remains a major renal replacement therapy for ESRD patients, has led to an increase in CVD-associated mortality following the longest interdialytic gap due to the accumulation of body fluids, electrolytes, and uremic toxins [2–5].
This study described the distribution of the day of the week of hospitalization for the various types of CVDs, based on HD schedules. Additionally, the influence of HD and FHD scheduling, on the day of the week of hospitalization for CVDs and IDs was investigated over a period of 20 years. Previous reports from the USRDS  and UKRR  demonstrated high hospitalization rates for CVDs following the long interdialytic interval; however, the time periods of these studies were only 4 and 5 years, respectively. There were also many variations in the treatment strategy and type of hospitalization (planned or emergency) among the institutions included in these studies.
HD schedules affected hospitalization for CVDs, but not for IDs. FHD may lower the day of the week risk of hospitalization. Our findings can help inform clinicians in selecting the dialysis modality as well as guide clinical management practices for CVDs and IDs in ESRD patients.