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Two-Day Dialysis Interval Could Pose Danger: Study
Date:9/22/2011

erage annual death rates were 22 percent on the day after the two-day interval compared to 18 percent on other days. The findings showed cardiac-related death rates were higher after the two-day interval, 10.2 percent compared to 7.5 percent after a one-day gap. Cardiac arrest after the longer interval was 1.3 percent compared to 1 percent, and deaths from heart attack were 6.3 percent vs. 4.4 percent.

Hospital admission rates were also steeper following the longer wait between dialysis visits. Hospitalization rates for heart attack were 6.3 percent compared to 3.9 percent, and congestive heart failure admission rates were almost double after a two-day interval (29.9 percent vs. 16.9 percent). Hospitalization rates for stroke were also higher (4.7 percent vs. 3.1 percent).

"This is a terrific study. Well-designed and clearly written," said Dr. Ajay Singh, an associate professor of medicine at Harvard Medical School and a practicing nephrologist. While the authors do not discuss the potential explanation for their findings, Singh said it's possible that the higher risk of death and hospitalization associated with the longer wait time stems from excessive fluid buildup or an electrolyte abnormality, perhaps related to elevated potassium levels, that harm the heart. Potassium is a mineral that can build up in blood and cause an abnormal heartbeat called an arrhythmia.

"The take-away message of the study is really something that many of us have known from our clinical practices for years -- that the long two-day interval between dialysis treatments in somebody on a three-day-a-week schedule is a point of high risk for heart attacks, congestive heart failure and hospital admissions," Zand said. "It begs the question, do we need to re-examine the three-day-a-week schedule?"

Foley said it's too early to change dialysis protocol. "Our study suggests that alternate-day treatment versus conventional three times per week treatment is a trial that needs
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