Interview with
Jeffrey H. Burbank
Founder& CEO of NxStage

Hemodialysis.com Editor Marie Benz: What are the main findings of the study?

The main finding of the study is that daily variation in cardiac death was only seen in in-center hemodialysis(HD) patients receiving 3 or fewer dialysis sessions per week but not in peritoneal dialysis, home HD or in-center dialysis receiving more than 3 sessions per week.

Cardiac death was significantly higher on Mondays for in center  HD patients receiving 3 or fewer dialysis sessions per week ( Adjusted OR ,1.26 95% CI 1.14-1.40, p<0.001)

Hemodialysis.com: Were any of the findings unexpected?

There was a lower odds of cardiac death on Saturdays and Sundays for in center HD patients receiving 3 or fewer dialysis sessions per week.
This observation may represent:
1)      Discovery bias( i.e in center HD patients dying on the weekend may be less likely be discovered until their next dialysis schedule).

2)      Stringent management of fluid prior to long breaks both by patients and HD staff(more assiduously achieving dry weight).

3)      A chance finding ( type 1 error.)

Hemodialysis.com: What should clinicians and patients take away from your report? 

Our large observational cohort study suggests that patients on PD, home HD and enhanced frequency HD (more than 3 sessions per week) do not experience the spike in cardiac death observed following the weekend interdialytic break in patients receiving receiving facility dialysis (£3 sessions/week).

Hemodialysis.com: What recommendations do you have for future research as a result of this study?  

We suggest further studies involving larger populations of home HD and enhanced frequency HD patients are required to be confident that a clinically important septadian pattern of cardiac mortality does not occur in these groups.

Reference:

Daily Variation in Death in Patients Treated by Long-term Dialysis: Comparison of In-Center Hemodialysis to Peritoneal and Home Hemodialysis  
Rathika Krishnasamy, Sunil V. Badve, Carmel M. Hawley, Stephen P. McDonald, Neil Boudville, Fiona G. Brown, Kevan R. Polkinghorne, Kym M. Bannister, Kathryn J. Wiggins, Philip Clayton, David W. Johnson

American Journal of Kidney Diseases - 20 August 2012 (10.1053/j.ajkd.2012.07.008