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• W2034138625 abstract "The risk of death for hemodialysis patients is thought to be highest on the days following the longest interval without dialysis (usually Mondays and Tuesdays); however, existing results are inconclusive. To clarify this we analyzed Dialysis Outcomes and Practice Patterns Study (DOPPS) data of 22,163 hemodialysis patients from the United States, Europe, and Japan. Our study focused on the association between dialysis schedule and day of the week of all-cause, cardiovascular, and noncardiovascular mortality with day-of-week coded as a time-dependent covariate. The models were adjusted for dialysis schedule, age, country, DOPPS phase I or II, and other demographic and clinical covariates, and compared mortality on each day to the 7-day average. Patients on a Monday–Wednesday–Friday (MWF) schedule had elevated all-cause mortality on Mondays, and those on a Tuesday–Thursday–Saturday (TTS) schedule had increased risk of mortality on Tuesdays in all three regions. The association between day-of-week mortality and schedule was generally stronger for cardiovascular than noncardiovascular mortality, and was most pronounced in the United States. Unexpectedly, Japanese patients on a MWF schedule had a higher risk of noncardiovascular mortality on Fridays, and European patients on a TTS schedule experienced an elevated cardiovascular mortality on Saturdays. Thus, future studies are needed to evaluate the influence of practice patterns on schedule-specific mortality and factors that could modulate this effect. The risk of death for hemodialysis patients is thought to be highest on the days following the longest interval without dialysis (usually Mondays and Tuesdays); however, existing results are inconclusive. To clarify this we analyzed Dialysis Outcomes and Practice Patterns Study (DOPPS) data of 22,163 hemodialysis patients from the United States, Europe, and Japan. Our study focused on the association between dialysis schedule and day of the week of all-cause, cardiovascular, and noncardiovascular mortality with day-of-week coded as a time-dependent covariate. The models were adjusted for dialysis schedule, age, country, DOPPS phase I or II, and other demographic and clinical covariates, and compared mortality on each day to the 7-day average. Patients on a Monday–Wednesday–Friday (MWF) schedule had elevated all-cause mortality on Mondays, and those on a Tuesday–Thursday–Saturday (TTS) schedule had increased risk of mortality on Tuesdays in all three regions. The association between day-of-week mortality and schedule was generally stronger for cardiovascular than noncardiovascular mortality, and was most pronounced in the United States. Unexpectedly, Japanese patients on a MWF schedule had a higher risk of noncardiovascular mortality on Fridays, and European patients on a TTS schedule experienced an elevated cardiovascular mortality on Saturdays. Thus, future studies are needed to evaluate the influence of practice patterns on schedule-specific mortality and factors that could modulate this effect. Hemodialysis (HD) patients usually experience relatively high mortality rates; for example, ∼23% per annum in the United States, 15% in Europe, and 9% in Japan. As the most common treatment of advanced kidney failure, HD typically requires patients to follow a strict treatment schedule, which typically entails receiving dialysis on a three times a week schedule, either Monday–Wednesday–Friday (MWF) or Tuesday–Thursday–Saturday (TTS). During the intervals between dialysis sessions, electrolytes, fluid, and various uremic toxins accumulate and, as a result, contribute to an increased risk of mortality. Therefore, the intermittent dialysis schedule, MWF or TTS, may put patients at a higher risk of death on certain days. In particular, patients on a MWF schedule may have higher risk of death on Mondays, whereas those on a TTS schedule may experience an elevated risk on Tuesdays, since these days follow the longest intervals without the benefit of dialysis. Various studies have assessed the association between day-of-week-specific mortality risk and dialysis schedule. For example, Bleyer et al.1.Bleyer A.J. Russell G.B. Satko S.G. Sudden and cardiac death rates in hemodialysis patients.Kidney Int. 1999; 55: 1553-1559Abstract Full Text Full Text PDF PubMed Scopus (308) Google Scholar found a significantly higher risk of sudden death and cardiac-related death on Mondays for MWF schedule patients, and on Tuesdays for TTS schedule patients. Karnik et al.2.Karnik J.A. Young B.S. Lew N.L. et al.Cardiac arrest and sudden death in dialysis units.Kidney Int. 2001; 60: 350-357Abstract Full Text Full Text PDF PubMed Scopus (280) Google Scholar identified modifiable risk factors for cardiac arrest in dialysis units, including age, diabetes, using a catheter for vascular access, and being hospitalized within the past 30 days. In addition, results from Karnik et al.2.Karnik J.A. Young B.S. Lew N.L. et al.Cardiac arrest and sudden death in dialysis units.Kidney Int. 2001; 60: 350-357Abstract Full Text Full Text PDF PubMed Scopus (280) Google Scholar revealed that there is a higher risk of cardiac arrest on Mondays for MWF schedule patients. Bleyer et al.3.Bleyer A.J. Hartman J. Brannon P.C. et al.Characteristics of sudden death in hemodialysis patients.Kidney Int. 2006; 69: 2268-2273Abstract Full Text Full Text PDF PubMed Scopus (296) Google Scholar applied a strict definition of sudden death and investigated the association between the timing of HD and occurrences of sudden death among HD patients. The authors found an increased risk of sudden death in the 12-h period after starting dialysis, and also in the 12-h period at the end of the weekend interval (that is, before starting HD, namely Monday and Tuesday). For several reasons, previously published studies should be interpreted with caution. Most prior studies were based on relatively small sample sizes; most were confined to US patients, limiting their generalizability. Moreover, statistical analyses were lacking in several respects. For example, results were sometimes based on crude death rates without covariate adjustment. In addition, for the most part, these analyses did not examine interactions between weekday and patient characteristics. For example, it is possible that mortality elevations on given days may be accentuated for various patient subgroups; for example, older patients, diabetics, and patients with various comorbid conditions. Our study uses data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), an international prospective observational study of HD treatment and patient outcomes. The DOPPS-I (1996–2001) comprised over 17,000 patients in seven countries (France, Germany, Italy, Japan, Spain, United Kingdom, and the United States) from more than 300 dialysis facilities. The DOPPS-II (2002–2004) population included over 12,000 patients in 12 countries (DOPPS-I countries plus Australia/New Zealand, Belgium, Canada, and Sweden) from more than 300 dialysis facilities. The sampled facilities have at least 20–25 HD patients and represent all geographic regions and all types of facilities in each country. The DOPPS selects a random sample of HD patients within each participating facility. In this study, we carry out a comprehensive investigation of the association between day-of-week-specific death rates and dialysis schedule, in the United States, Japan, and several European countries (Belgium, France, Germany, Italy, Spain, Sweden, and United Kingdom). In addition to having a very large sample size and long follow-up period, the DOPPS database contains information on many demographic variables and comorbid conditions. As the end point is time to death, we used survival analysis (Cox regression) with day of the week serving as a time-dependent covariate. Cox regression is well-suited for this purpose as it is designed to handle a data structure where time until death is potentially censored and accurately tracks which patients are at risk on a particular weekday. Thus, Cox regression appropriately accounts for deaths and right censoring as they occur. Baseline characteristics of the prevalent cross-section of patients are presented in Table 1 by region. Compared with US patients, European and Japanese patients were, on average, more likely to be men, have lower body mass index, and less likely to have diabetes and cardiovascular disease (CVD). European patients tended to be older than US patients, whereas Japanese patients were on average younger than US patients. Each of these differences was statistically significant (P<0.05). Subsequent models were constructed from both prevalent (cross-sectional) and incident patients.Table 1Demographics by regionUnited States (N=4666)Europe (N=5623)Japan (N=3531)Black (%)35.81.50Male (%)54.257.861.8Age (years)61.1 (15.2)62.1 (15.1)59.7 (12.6)BMI (kg/m2)25.1 (6.1)23.9 (4.7)20.3 (3.1)Diabetes48.523.326.9CVD74.965.846.3Abbreviations: BMI, body mass index; CVD, cardiovascular disease.Values in the parentheses are the standard deviations.This table is based on prevalent cross-sections of hemodialysis (HD) patients participating in either Dialysis Outcomes and Practice Patterns Study (DOPPS) I or II.CVD corresponds to any of the following comorbid conditions: cerebrovascular disease, congestive heart failure, coronary heart disease, or other cardiovascular diseases. Open table in a new tab Abbreviations: BMI, body mass index; CVD, cardiovascular disease. Values in the parentheses are the standard deviations. This table is based on prevalent cross-sections of hemodialysis (HD) patients participating in either Dialysis Outcomes and Practice Patterns Study (DOPPS) I or II. CVD corresponds to any of the following comorbid conditions: cerebrovascular disease, congestive heart failure, coronary heart disease, or other cardiovascular diseases. In total, 4395 deaths were reported during the study period. Of the deaths, 2663 were among US patients, 1391 among European patients, and 341 among Japanese patients. In addition, 1744 out of 4395 (40%) deaths were caused by CVD. A total of 2489 out of 4395 (57%) deaths were among patients on a MWF schedule, whereas 1906 (43%) were among those on a TTS schedule. The distribution of deaths by day of the week for each dialysis schedule group is shown in Figure 1. For MWF schedule patients, Monday had a much higher percentage of deaths for US, European, and Japanese patients (19.7%, 19.6%, and 17.9%, respectively). For TTS schedule patients, Tuesday had the highest percentage of deaths for US, European, and Japanese patients (19.2%, 16.9%, and 19.1%, respectively). The distributions varied a little by region. For MWF schedule patients, Friday appears to have the highest risk of death in Japan, with ∼1/5 deaths occurring on that day. For TTS schedule patients, Monday appears to have a higher risk of death in the United States (15.7%), whereas Saturday appears to have a higher risk of death in Europe and Japan (18% for both). For each region, Cox regression models were used to estimate the covariate-adjusted day-of-week effect on death hazard, with day of the week coded as a time-dependent covariate. The model was set up so that the mortality hazard on each day was compared with the 7-day average. Figure 2 contains three sets of covariate-adjusted hazard ratios (HRs) for all-cause mortality by day of the week with MWF schedule for US patients (Figure 2a), European patients (Figure 2b), and Japanese patients (Figure 2c). Patients on a MWF dialysis schedule from the United States experienced a significant (P<0.0001) 41% higher risk of all-cause death on Mondays relative to the 7-day average. European patients experienced a significant 34% higher risk of all-cause death on Mondays versus the 7-day average (P=0.001), whereas patients from Japan experienced a 27% higher risk of all-cause death on Mondays (P=0.154), as well as a 44% higher mortality risk on Fridays (P=0.04). Corresponding results for TTS schedule patients are shown in Figure 3, with each weekday again being compared with the overall average. A significant 39% higher risk of all-cause mortality was observed on Tuesdays for the US patients (P<0.0001). European patients experienced a significant 22% higher risk of all-cause death on Tuesdays (P=0.043) and a significant 31% higher risk of all-cause death on Saturdays (P=0.013). Japanese patients experienced a significant 43% higher risk of all-cause death on Tuesdays (P=0.044), as well as a 43% higher risk on Saturdays (P=0.07). Figure 4 shows covariate-adjusted HRs of CVD and non-CVD mortality by day of the week for MWF schedule patients. In the United States, CVD mortality risk was higher by 45% on Mondays relative to the 7-day average (P<0.0001); the corresponding value for non-CVD mortality was 38% (P<0.0001). In Europe, patients experienced a significant 55% higher risk of CVD mortality on Mondays (P=0.006), while also experiencing a significant 27% higher risk of non-CVD mortality on Mondays (P=0.023). In Japan, CVD mortality risk was higher by 62% on Mondays (P=0.098); the corresponding value for non-CVD mortality was 10% (P=0.674). Japanese patients, however, experienced a significant 100% higher non-CVD mortality risk on Fridays versus the 7-day average (P=0.001). In Figure 5, HRs of CVD and non-CVD mortality by day of the week for TTS schedule patients is displayed. In the United States, CVD mortality risk was higher by 56% on Tuesdays relative to the 7-day average (P<0.0001); patients also experienced a significant 26% higher non-CVD mortality risk on Tuesdays (P=0.016). In Europe, patients experienced a 43% higher risk of CVD mortality on Tuesdays (P=0.058), with the corresponding value for non-CVD mortality being 15% (P=0.236). However, European patients had an 88% higher risk of CVD death on Saturdays (P=0.001). In Japan, patients experienced a significant 75% higher risk of CVD mortality on Tuesdays (P=0.037) and also experienced a 93% higher CVD mortality risk on Saturdays (P=0.034). However, in Japan there was no evidence of higher non-CVD mortality on Tuesdays compared with the 7-day average (HR=1.26; P=0.300). Cox models were fitted to all patients (that is, combining the United States, Europe, and Japan) to study which patient characteristics were associated with the day-of-week effect on all-cause mortality. For this part of the analysis, we focused specifically on the impact of sex, 14 comorbid conditions, and vascular access type on each of the two effects: the mortality elevation on Mondays (for MWF schedule patients) and that on Tuesdays (for TTS patients). The results are listed in Tables 2 and 3. None of the above-listed factors seemed to modulate the effects, with the possible exceptions of cancer (other than skin) being associated with a lower risk of all-cause mortality on Mondays (for MWF schedule patients) and on Tuesdays (for TTS patients; HR=1.18 for patients with cancer (other than skin), HR=1.40 for patients without cancer (other than skin), P-value=0.033); neurological disease being associated with a higher risk of all-cause mortality on Mondays (MWF schedule) and on Tuesdays (TTS schedule; HR=1.59 for patients with neurological disease, HR=1.33 for patients without neurological disease, P-value=0.041); and sex, where the effect on Tuesday was higher for men on a TTS schedule.Table 2RR of death (all-cause) by sex (United States, Europe, and Japan)ComparisonScheduleRR, maleRR, femaleP-value (difference)Monday vs. AvgMWF1.321.470.152Tuesday vs. AvgTTS1.451.200.028Abbreviations: Avg, average; MWF, Monday–Wednesday–Friday; RR, relative risk; TTS, Tuesday–Thursday–Saturday. Open table in a new tab Table 3Modification of Monday and Tuesday effect by comorbid conditions and by using catheter as vascular access (United States, Europe, and Japan)Comorbid conditionsInteraction with Monday and TuesdayComorbid conditionsInteraction with Monday and TuesdayCerebrovascular disease1.03 (0.699)HIV0.79 (0.383)Congestive heart failure0.99 (0.891)Hypertension1.09 (0.210)Coronary heart disease1.05 (0.380)Lung disease1.00 (0.956)Other cardiovascular diseases1.02 (0.696)Neurological disease1.20 (0.039)Cancer (other than skin)0.84 (0.034)Peripheral vascular disease1.05 (0.400)Diabetes1.01 (0.924)Psychiatric disorder0.92 (0.166)Gastrointestinal bleeding1.01 (0.955)Recurring cellulitis, gangrene1.01 (0.899)Catheter useInteraction with Monday and TuesdayCatheter0.98 (0.760)Numbers in the parentheses are the corresponding P-values.A value of <1 (>1) means the factor was associated with a decreased (increased) risk of all-cause mortality on Mondays with Monday–Wednesday–Friday (MWF) schedule and on Tuesdays with Tuesday–Thursday–Saturday (TTS) schedule. Open table in a new tab Abbreviations: Avg, average; MWF, Monday–Wednesday–Friday; RR, relative risk; TTS, Tuesday–Thursday–Saturday. Numbers in the parentheses are the corresponding P-values. A value of <1 (>1) means the factor was associated with a decreased (increased) risk of all-cause mortality on Mondays with Monday–Wednesday–Friday (MWF) schedule and on Tuesdays with Tuesday–Thursday–Saturday (TTS) schedule. A final Cox model was fitted, which combined DOPPS-I patients from the United States, Europe, and Japan, to determine whether time-dependent measures of blood pressure, potassium, sodium, ultrafiltration rate, intradialytic weight loss, residual renal function (RRF), and the use of diuretics modify the Monday and Tuesday effects. Table 4 shows that low ultrafiltration rate was associated with higher risk of all-cause mortality on Mondays with MWF schedule and on Tuesdays with TTS schedule. Diuretic use was associated with lower risk of all-cause mortality on Mondays with MWF schedule and on Tuesdays with TTS schedules.Table 4Modification of Monday and Tuesday effect by time-dependent factors (DOPPS-I: United States, Europe, and Japan)Time-dependent covariateInteraction with Monday and TuesdayTime-dependent covariateInteraction with Monday and TuesdayBlood pressure low0.84 (0.054)Blood pressure high1.19 (0.140)Potassium low0.85 (0.142)Potassium high1.15 (0.275)Sodium low1.08 (0.496)Sodium high1.06 (0.662)Ultrafiltration rate low1.28 (0.019)Ultrafiltration rate high0.94 (0.570)Weight loss low1.11 (0.292)Weight loss high1.07 (0.609)RRF0.80 (0.096)Diuretic use0.62 (0.003)Abbreviations: DOPPS-I, Dialysis Outcomes and Practice Patterns Study, phase I; RRF, residual renal function.Numbers in the parentheses are the corresponding P-values.A value of <1 (>1) means the factor was associated with a decreased (increased) risk of all-cause mortality on Mondays with Monday–Wednesday–Friday (MWF) schedule and on Tuesdays with Tuesday–Thursday–Saturday (TTS) schedule. Open table in a new tab Abbreviations: DOPPS-I, Dialysis Outcomes and Practice Patterns Study, phase I; RRF, residual renal function. Numbers in the parentheses are the corresponding P-values. A value of <1 (>1) means the factor was associated with a decreased (increased) risk of all-cause mortality on Mondays with Monday–Wednesday–Friday (MWF) schedule and on Tuesdays with Tuesday–Thursday–Saturday (TTS) schedule. Despite its proven value as a life-saving therapy, HD remains an intermittent intervention, most typically administered three times a week. Harmful waste products and fluid accumulated over the extended weekend interval may therefore put patients at a higher risk of death on certain days. Our results from the DOPPS in the US, European, and Japanese patients indicate that, in all three regions, HD patients have a higher risk of all-cause death on Mondays if they are on a MWF schedule, or Tuesdays if they are on a TTS schedule. Thus, findings from prior reports1.Bleyer A.J. Russell G.B. Satko S.G. Sudden and cardiac death rates in hemodialysis patients.Kidney Int. 1999; 55: 1553-1559Abstract Full Text Full Text PDF PubMed Scopus (308) Google Scholar,3.Bleyer A.J. Hartman J. Brannon P.C. et al.Characteristics of sudden death in hemodialysis patients.Kidney Int. 2006; 69: 2268-2273Abstract Full Text Full Text PDF PubMed Scopus (296) Google Scholar are corroborated and expanded upon here. This day-of-week effect tends to be stronger for CVD than non-CVD death overall. The European and Japanese data tend to confirm the effect, quite evident in the US data, of increased mortality on the day of the first dialysis session in the week. On the other hand, there are unique features to the results in Europe and Japan, such as high mortality on Saturdays in the TTS schedule, which may be due to practice patterns unique to those countries/regions. Such practice patterns could, for example, include continued aggressive/usual ultrafiltration and dialysis on Fridays or Saturdays (the last dialysis session of the week) in order to allow for the anticipated longer weekend gap in dialysis, despite the patients being closer to their target postdialysis weight at the time of the last dialysis session of the week. This could predispose to a greater degree of intradialytic hypotension and/or hypokalemia, which in turn would increase the tendency for CVD events, including sudden death. However, this mechanism, although plausible, remains speculative. Nondialysis days had lower relative risks for mortality compared with dialysis days, perhaps because dialysis itself increases the risk of mortality. For HD patients, very large amounts of fluids and toxins are removed in a relatively short time period, particularly if the time elapsed since the last dialysis is long. This increases the potential for occurrence of intradialytic hypotension, which has previously been found to be a risk factor for mortality among HD patients.4.Zager P.G. Nikolic J. Brown R.H. et al.U curve association of blood pressure and mortality in hemodialysis patients.Kidney Int. 1998; 54: 561-569Abstract Full Text Full Text PDF PubMed Scopus (593) Google Scholar,5.Shoji T. Tsubakihara Y. Fujii M. et al.Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients.Kidney Int. 2004; 66: 1212-1220Abstract Full Text Full Text PDF PubMed Scopus (469) Google Scholar Rapid reduction in postdialysis potassium may also be a contributory factor, as hypokalemia can enhance the risk for cardiac arrhythmia and sudden death, and this is more likely to occur on a dialysis day as opposed to the day preceding dialysis. This study presents some evidence that the day-of-week effect is modulated by cancer (other than skin), neurological disease, sex, low ultrafiltration rate, and use of diuretics, but, apparently, not by other suspected factors including other comorbid conditions, blood pressure, serum potassium, serum sodium, intradialytic weight loss, and RRF (the hazard ratio for the interaction with day of the week in this instance was protective but statistically nonsignificant). Potential explanations toward the interpretation of some of these interactions are again speculative. For those with cancer, it could be speculated that the interaction with first day of the week was associated with lower mortality because the mechanism of death may predominantly be through noncardiovascular mechanisms. Those with neurological disease may have an accentuated early-in-the-week effect because of vascular diseases being the underlying cause for many types of neurological diseases (for example, cerebrovascular disease). Similarly, males have a greater association with CVD and hence may have an interaction with early-in-the-week mortality. Low ultrafiltration rate may at least in part reflect patients especially prone to dialysis-related hypotension, which is itself a predictor of worse patient outcomes, particularly the finding that modification of the early-in-the-week mortality risk in association with diuretic use has therapeutic implications, especially in patients with significant RRF who are likely to be responsive to diuretic therapy. This is consistent with previously published DOPPS findings showing a lower mortality among those receiving diuretics.6.Bragg-Gresham J.L. Fissell R.B. Mason N.A. et al.Diuretic use, residual renal function, and mortality among hemodialysis patients in the Dialysis Outcomes and Practice Pattern Study (DOPPS).Am J Kidney Dis. 2007; 49: 426-431Abstract Full Text Full Text PDF PubMed Scopus (105) Google Scholar Low ultrafiltration may represent patients with low blood pressure to begin with, or those who are malnourished, thus being associated with higher early-in-the-week mortality. Clearly, associations found in these exploratory analyses require confirmation in future studies. Some limitations of our study are as follows. Dialysis schedule was inferred from the date of reporting of dose of dialysis, which was collected once every 4 months. It was not possible to obtain the schedule information directly. In addition, the DOPPS data do not include the exact time of death or the timing of dialysis sessions, both of which would be useful additional data in further understanding the day-of-week effect. The secondary end point of CVD death is certainly of interest, but CVD death may not be ascertained completely or determined consistently across centers. Such limitations are typical of studies using large observational databases. Because of both the smaller sample size and lower event rate, inferences pertaining to Japanese HD patients are subject to substantially more uncertainty than those for US patients. Countries within Europe also have smaller sample sizes. However, these countries share similar genetic and environmental factors, as well as practice patterns, at least to some extent. In the analyses reported here, Europeans were considered as a single group, and conclusions were made about average effects over the 5–7 countries from this entire region. Larger samples from each country could examine differences within Europe. DOPPS-II also includes data from Canada, Australia, and New Zealand, but the sample sizes in these countries were too small to support reliable conclusions in this study. Noncompliance has been observed to be most common in the United States and least common in Japan. Non-adherence with dialysis sessions (‘shortening’ or ‘skipping’ sessions) has been associated with higher mortality as detailed in a previous DOPPS paper,7.Saran R. Bragg-Gresham J.L. Rayner H.C. et al.Nonadherence in hemodialysis: associations with mortality, hospitalization, and practice patterns in the DOPPS.Kidney Int. 2003; 64: 254-262Abstract Full Text Full Text PDF PubMed Scopus (370) Google Scholar and would be expected to raise overall mortality rates. Unfortunately, there is insufficient information to assess the rate or effect of noncompliance in the DOPPS data. Finally, a substantial proportion (66%) of patients died in the hospital. Often, patients who are hospitalized would no longer follow their regular dialysis schedule. In this case, one would expect the observed day-of-week effect in this study to be somewhat attenuated. Further study that considered the potential confounding effect of hospitalization would be valuable. Our results imply that there may be an advantage to a more frequent dialysis schedule in Europe, the United States, and potentially Japan. This is supported by the relatively low rates of mortality for patients receiving ‘daily dialysis’ based on various reports.8.Woods J.D. Port F.K. Orzol S. et al.Clinical and biochemical correlates of starting “daily” hemodialysis.Kidney Int. 1999; 55: 2467-2476Abstract Full Text Full Text PDF PubMed Scopus (195) Google Scholar, 9.Blagg C.R. Kjellstrand C.M. Ting G.O. et al.Comparison of survival between short-daily hemodialysis and conventional hemodialysis using the standardized mortality ratio.Hemodialysis Int. 2006; 10: 371-374Crossref PubMed Scopus (71) Google Scholar, 10.Kjellstrand C.M. Buoncristiani U. Ting G. et al.Short daily haemodialysis: survival in 415 patients treated for 1006 patient-years.Nephrol Dial Transpant. 2008; 23: 3283-3289Crossref PubMed Scopus (162) Google Scholar, 11.Johansen K.L. Zhang R. Huang Y. et al.Survival and hospitalization among patients using nocturnal and short daily compared to conventional hemodialysis: a USRDS study.Kidney Int. 2009; 76: 984-990Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar One could hypothesize that more frequent dialysis would reduce or eliminate the day-of-week effect and, therefore, lower mortality on HD. Many previous reports have found that daily dialysis is beneficial. For example, Woods et al.8.Woods J.D. Port F.K. Orzol S. et al.Clinical and biochemical correlates of starting “daily” hemodialysis.Kidney Int. 1999; 55: 2467-2476Abstract Full Text Full Text PDF PubMed Scopus (195) Google Scholar found that for certain patients daily HD might have advantages over three times a week HD. Blagg et al.9.Blagg C.R. Kjellstrand C.M. Ting G.O. et al.Comparison of survival between short-daily hemodialysis and conventional hemodialysis using the standardized mortality ratio.Hemodialysis Int. 2006; 10: 371-374Crossref PubMed Scopus (71) Google Scholar observed that patients treated by short daily HD had a better survival rate than those treated by conventional HD. Kjellstrand et al.10.Kjellstrand C.M. Buoncristiani U. Ting G. et al.Short daily haemodialysis: survival in 415 patients treated for 1006 patient-years.Nephrol Dial Transpant. 2008; 23: 3283-3289Crossref PubMed Scopus (162) Google Scholar reported that the survival of United States Renal Data System patients on short daily HD was 2–3 times lower than that of matched three times a week HD patients. Johansen et al.11.Johansen K.L. Zhang R. Huang Y. et al.Survival and hospit" @default.
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• W2034138625 title "Dialysis outcomes and analysis of practice patterns suggests the dialysis schedule affects day-of-week mortality" @default.
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