Key result
Post-dialysis 12-hour sudden cardiac death is linked to ~68% higher risk following 3-day intervals.
Why the study?
Maintenance hemodialysis patients have increased mortality across interdialytic intervals of thrice-weekly schedules, but the impact of interdialytic intervals on sudden cardiac death in twice-weekly schedules was unstudied.
Does the timing of the interdialytic interval affect the risk of sudden cardiac death in end-stage renal disease patients on a twice-weekly hemodialysis schedule?
Cohort (n=413)
No
Does the timing of the interdialytic interval affect the risk of sudden cardiac death in end-stage renal disease patients on a twice-weekly hemodialysis schedule?
In patients on a twice-weekly hemodialysis schedule, the risk of sudden cardiac death is significantly amplified in the 12 hours immediately following a long (3-day) interdialytic gap and the 12 hours preceding a short (2-day) interval, underscoring the arrhythmogenic hazard of extreme fluid and electrolyte shifts.
SCD risk peaks after long interdialytic intervals in twice-weekly HD; hypothesis-generating for schedule optimization trials.
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.
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Kumar et al. (2025) conducted a cohort in End-stage kidney disease on twice-weekly maintenance hemodialysis (n=413). Hemodialysis interdialytic intervals vs. Expected uniform mortality across the weekly cycle was evaluated on Sudden cardiac death in the first 12 hours after dialysis following a 3-day long interdialytic interval (SMR 1.68, 95% CI 1.24-2.18). Sudden cardiac death was significantly increased in the first 12 hours post-dialysis following a 3-day long interdialytic interval (SMR 1.68).
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