Chronotype-Guided Hemodialysis Scheduling and Its Association with Intradialytic Blood Pressure Variability and Quality of Life

Background: Hemodialysis in chronic kidney disease (CKD) patients can disrupt circadian rhythms, and together with chronotype differences, this may influence cardiovascular risk and blood pressure (BP) variability depending on dialysis timing. This work aimed to explore the relationship between chronodisruption, chronotype distribution, and their effects on change in intradialytic BP variability and quality of life (QoL) among patients with kidney failure receiving maintenance hemodialysis. Methods: This prospective single-arm interventional study was carried out on 120 prevalent hemodialysis patients, who had been kept on a regular dialysis schedule for six to 12 months, were registered and controlled hypertensive patients compliant with anti-hypertensive medications, taken one hour before the initiation of dialysis sessions. All patients were subjected to clinical examination, assessment of work schedule, chronotype, sleep assessment, QoL and adherence, laboratory investigation, and radiological examination. Results: Chronotype-based modification of hemodialysis timing resulted in significant improvements across multiple outcomes. Significant differences were observed in laboratory parameters, dialysis session characteristics, session timing, QoL scores, and the number of missed sessions per month after intervention (P<0.05). Medical counseling attendance showed no significant change among morning-type patients (P>0.05), whereas evening-type patients demonstrated a significant improvement (P<0.05). Sleep duration increased significantly in both groups (P<0.05), with greater improvement among evening-type individuals. Conclusions: Aligning hemodialysis timing with a patient’s chronotype improved treatment outcomes, enhanced hemodynamic stability, and increased overall QoL by supporting circadian rhythm balance.