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Traditional kidney-dialysis schedule questioned
Study: Hospitalizations, deaths rise on 3rd day of thrice-weekly treatment
Question of the Day
LOS ANGELES — A major new study challenges the way diabetics and others with failing kidneys have been treated for half a century, finding that three-times-a-week dialysis to cleanse the blood of toxins may not be enough.
Deaths, heart attacks and hospitalizations were much higher on the day after the two-day interval between treatments each week than at other times, the federally funded study found.
The president of the National Kidney Foundation said she was “very troubled” by the results, which are to be published in Thursday’s New England Journal of Medicine.
“We could be doing a better job for our dialysis patients” and that might mean doing it more often, said Dr. Lynda Szczech, a Duke University kidney specialist who had no role in the study.
Kidneys rid the body of waste and fluids. Most of the 400,000 Americans with failing kidneys stay alive by getting their blood purified by a machine three days a week at dialysis clinics. Typically, there’s a two-day break between the last session of the week and the next one.
The three-day dialysis schedule has been around since the mid-1960s and gives patients a weekend break from the grueling hours of being hooked up to a machine.
However, doctors have suspected that the two-day hiatus between treatments was risky, and smaller studies have found more heart-related deaths on the day after the gap.
“All the fluids and toxins are built up to the highest extent on Monday morning right before dialysis,” said Dr. Anthony Bleyer of Wake Forest Baptist Medical Center in North Carolina, who has done similar studies.
The latest research, funded by the National Institutes of Health, is the largest yet. It was done by Dr. Robert Foley of the University of Minnesota and colleagues. All reported receiving fees from dialysis clinics and suppliers.
The team analyzed medical records of 32,000 people who had in-center dialysis three times a week from 2005 through 2008. The average age was 62 and a quarter had been on dialysis for a year or less. After about two years of follow-up, 41 percent had died, including 17 percent from heart-related causes.
Monday was the riskiest day for people on a Monday-Wednesday-Friday schedule. For those on a Tuesday-Thursday-Saturday schedule, the riskiest day was Tuesday.
Researchers found a 22 percent higher risk of death on the day after a long break compared with other days of the week. Put another way: For every 100 people on dialysis for a year, 22 would die on the day after the long interval versus 18 on other days.
Dr. Paul Eggers of the National Institute of Diabetes and Digestive and Kidney Diseases said adjusting how dialysis is done “would require some fairly convincing evidence. I’m not sure this one study would be sufficient to change” standard practice.
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