Impact of Interdialytic Intervals on Sudden Cardiac Death in Chronic Kidney Disease Stage 5D Patients on a Twice-Weekly Hemodialysis Schedule.

Abstract

Introduction: End-stage kidney disease patients on maintenance hemodialysis (HD) are prone to increase cardiovascular and non-cardiovascular mortality at long and short interdialytic intervals of an intermittent thrice-weekly schedule. Variations in fluid and electrolyte status during and in dialysis-free periods may predispose patients to sudden cardiac death (SCD). We studied SCD in HD in relation to the interdialytic interval in patients on a twice-weekly HD schedule.

Methods: An ambispective cohort study was done and data of HD patients on a twice-weekly schedule were collected from January 2009 to December 2017. The primary outcome was cardiovascular mortality and the secondary outcome was an estimate of the standard mortality ratio (SMR) at each 12-h period interval of the HD schedule. Deaths were categorized as SCD, non-SCD, and non-cardiac death as per standard definitions.

Results: Of 413 participants, 289 died. The rate of cardiovascular death accounted for 121 (42%), and non-cardiac death was 168 (58.1%). SCD was the most common cardiovascular event, accounting for 83 (28.7%) of overall mortality. SCD is more likely to occur in the first 12 h after dialysis following the 3-day-long interdialytic interval (SMR: 1.68) and in the 12 h before the next dialysis session after a short interval (SMR: 1.39).

Conclusion: Occurrence of SCD was higher at two different time points, i.e., 12-h period from the starting with the dialysis procedure and 12-h period before the start of the next session of HD at the end of a short interval.