Sudden and cardiac death rates in hemodialysis patients

Background. Sudden and cardiac death (including death from congestive heart failure, myocardial infarction, and sudden death) are common occurrences i n hemodialysis patients. The intermittent nature of hemodialysis may lead t o an uneven distribution of sudden and cardiac death throughout the week. T he purpose of this study was to assess the septadian rhythm of sudden and c ardiac death in hemodialysis patients. Methods. Data from the United States Renal Data System (USRDS) were obtaine d to examine the day of death for United States hemodialysis and peritoneal dialysis patients from 1977 through 1997. The days of death were also dete rmined for patients in the Case Mix Adequacy Study of the USRDS. Results. There was an even distribution of sudden and cardiac deaths for pa tients on peritoneal dialysis, and hemodialysis patients dying of noncardia c deaths also had an even distribution. For all hemodialysis patients, Mond ay and Tuesday were the most common days of sudden and cardiac death. For p atients in the Case Mix Adequacy Study designated as Monday, Wednesday, and Friday dialysis patients, 20.8% of sudden deaths occurred on Monday compar ed with the 14.3% expected (P = 0.002). Similarly, 20.2% of cardiac deaths occurred on Monday compared with the 14.3% expected (P = 0.0005). Similar t rends were found on Tuesday for Tuesday, Thursday, and Saturday dialysis pa tients; Conclusions. The intermittent nature of hemodialysis may contribute to an i ncreased sudden and cardiac death rate on Monday and Tuesday for patients e nrolled in the USRDS.