TY - JOUR
T1 - Daily variation in death in patients treated by long-term dialysis
T2 - Comparison of in-center hemodialysis to peritoneal and home hemodialysis
AU - Krishnasamy, Rathika
AU - Badve, Sunil V.
AU - Hawley, Carmel M.
AU - McDonald, Stephen P.
AU - Boudville, Neil
AU - Brown, Fiona G.
AU - Polkinghorne, Kevan R.
AU - Bannister, Kym M.
AU - Wiggins, Kathryn J.
AU - Clayton, Philip
AU - Johnson, David W.
N1 - Funding Information:
Financial Disclosure: Dr Johnson is a consultant for Baxter Healthcare Pty Ltd and previously has received research funds from this company. He has also received speakers' honoraria and research grants from Fresenius Medical Care and is a current recipient of a Queensland Government Health Research Fellowship. Dr Bannister is a consultant for Baxter Healthcare Pty Ltd. Dr Brown is a consultant for Baxter and Fresenius and has received travel grants from Amgen and Roche . Dr Polkinghorne has received speaking honoraria and travel grants from Amgen Australia. Assoc Prof Hawley has received research funding from Baxter Healthcare Pty Ltd and Fresenius Medical Care. She also has received travel grants from Amgen Australia. Dr McDonald is a consultant for Amgen Australia and Shire Australia. Assoc Prof Boudville previously has received research funds from Roche; travel grants from Roche , Amgen , and Jansen Cilag ; and speaking honoraria from Roche. The remaining authors declare that they have no relevant financial interests.
PY - 2013/1
Y1 - 2013/1
N2 - Background: There has been little study to date of daily variation in cardiac death in dialysis patients and whether such variation differs according to dialysis modality and session frequency. Study Design: Observational cohort study using ANZDATA (Australia and New Zealand Dialysis and Transplant) Registry data. Setting & Participants: All adult patients with end-stage kidney failure treated by dialysis in Australia and New Zealand who died between 1999 and 2008. Predictors: Timing of death (day of week), dialysis modality, hemodialysis (HD) session frequency, and demographic, clinical, and facility variables. Outcomes & Measurements: Cardiac and noncardiac mortality. Results: 14,636 adult dialysis patients died during the study period (HD, n = 10,338; peritoneal dialysis [PD], n = 4,298). Cardiac death accounted for 40% of deaths and was significantly more likely to occur on Mondays in in-center HD patients receiving 3 or fewer dialysis sessions per week (n = 9,503; adjusted OR, 1.26; 95% CI, 1.14-1.40; P < 0.001 compared with the mean odds of cardiac death for all days of the week). This daily variation in cardiac death was not seen in PD patients, in-center HD patients receiving more than 3 sessions per week (n = 251), or home HD patients (n = 573). Subgroup analyses showed that deaths related to hyperkalemia and myocardial infarction also were associated with daily variation in risk in HD patients. This pattern was not seen for vascular, infective, malignant, dialysis therapy withdrawal, or other deaths. Limitations: Limited covariate adjustment. Residual confounding and coding bias could not be excluded. Possible type 2 statistical error due to limited sample size of home HD and enhanced-frequency HD cohorts. Conclusions: Daily variation in the pattern of cardiac deaths was observed in HD patients receiving 3 or fewer dialysis sessions per week, but not in PD, home HD, and HD patients receiving more than 3 sessions per week.
AB - Background: There has been little study to date of daily variation in cardiac death in dialysis patients and whether such variation differs according to dialysis modality and session frequency. Study Design: Observational cohort study using ANZDATA (Australia and New Zealand Dialysis and Transplant) Registry data. Setting & Participants: All adult patients with end-stage kidney failure treated by dialysis in Australia and New Zealand who died between 1999 and 2008. Predictors: Timing of death (day of week), dialysis modality, hemodialysis (HD) session frequency, and demographic, clinical, and facility variables. Outcomes & Measurements: Cardiac and noncardiac mortality. Results: 14,636 adult dialysis patients died during the study period (HD, n = 10,338; peritoneal dialysis [PD], n = 4,298). Cardiac death accounted for 40% of deaths and was significantly more likely to occur on Mondays in in-center HD patients receiving 3 or fewer dialysis sessions per week (n = 9,503; adjusted OR, 1.26; 95% CI, 1.14-1.40; P < 0.001 compared with the mean odds of cardiac death for all days of the week). This daily variation in cardiac death was not seen in PD patients, in-center HD patients receiving more than 3 sessions per week (n = 251), or home HD patients (n = 573). Subgroup analyses showed that deaths related to hyperkalemia and myocardial infarction also were associated with daily variation in risk in HD patients. This pattern was not seen for vascular, infective, malignant, dialysis therapy withdrawal, or other deaths. Limitations: Limited covariate adjustment. Residual confounding and coding bias could not be excluded. Possible type 2 statistical error due to limited sample size of home HD and enhanced-frequency HD cohorts. Conclusions: Daily variation in the pattern of cardiac deaths was observed in HD patients receiving 3 or fewer dialysis sessions per week, but not in PD, home HD, and HD patients receiving more than 3 sessions per week.
KW - Cardiac failure
KW - cardiovascular disease
KW - cerebrovascular accident
KW - hemodialysis
KW - hyperkalemia
KW - incidence
KW - myocardial infarction
KW - peritoneal dialysis
KW - prevalence
KW - septadian rhythm
KW - stroke
KW - sudden cardiac death
KW - treatment modality
UR - http://www.scopus.com/inward/record.url?scp=84871228560&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2012.07.008
DO - 10.1053/j.ajkd.2012.07.008
M3 - Article
C2 - 22901771
AN - SCOPUS:84871228560
VL - 61
SP - 96
EP - 103
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 1
ER -