DIALYSIS SESSION TIMING AND OUTCOMES: MORTALITY AND HOSPITALIZATION DIFFERENCES ACROSS MORNING, AFTERNOON, AND NIGHT SHIFTS IN HEMODIALYSIS PATIENTS

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DIALYSIS SESSION TIMING AND OUTCOMES: MORTALITY AND HOSPITALIZATION DIFFERENCES ACROSS MORNING, AFTERNOON, AND NIGHT SHIFTS IN HEMODIALYSIS PATIENTS

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Co-author 1

Xindong Wu wu.xindong@zs-hospital.sh.cn Zhongshan Hospital, Fudan Univeristy Nephrology Shanghai China -

Co-author 2

Weidong Zhang zhang.weidong@zs-hospital.sh.cn Zhongshan Hospital, Fudan Univeristy Nephrology Shanghai China -

Co-author 3

Xiaoyan Jiao jiao.xiaoyan@zs-hospital.sh.cn Zhongshan Hospital, Fudan Univeristy Nephrology Shanghai China -

Co-author 4

Jialin Wang wang.jialin@zs-hospital.sh.cn Zhongshan Hospital, Fudan Univeristy Nephrology Shanghai China -

Co-author 5

Zhonghua Liu liu.zhonghua@zs-hospital.sh.cn Zhongshan Hospital, Fudan Univeristy Nephrology Shanghai China -

Co-author 6

Xuesen Cao cao.xuesen@zs-hospital.sh.cn Zhongshan Hospital, Fudan Univeristy Nephrology Shanghai China -

Co-author 7

Fangfang Xiang xiang.fangfang@zs-hospital.sh.cn Zhongshan Hospital, Fudan Univeristy Nephrology Shanghai China -

Co-author 8

Yang Li li.yang@zs-hospital.sh.cn Zhongshan Hospital, Fudan Univeristy Nephrology Shanghai China -

Co-author 9

Bo Shen shen.bo@zs-hospital.sh.cn Zhongshan Hospital, Fudan Univeristy Nephrology Shanghai China -

Co-author 10

Jianzhou Zou zou.jianzhou@zs-hospital.sh.cn Zhongshan Hospital, Fudan Univeristy Nephrology Shanghai China -

Co-author 11

Yongmei Zhang zhang.yongmei@zs-hospital.sh.cn Zhongshan Hospital, Fudan Univeristy Nephrology Shanghai China -

Co-author 12

Xiaoqiang Ding ding.xiaoqiang@zs-hospital.sh.cn Zhongshan Hospital, Fudan Univeristy Nephrology Shanghai China -

Co-author 13

Jieru Cai cai.jieru@zs-hospital.sh.cn Zhongshan Hospital, Fudan Univeristy Nephrology Shanghai China -

Co-author 14

Shengzhuo Yao youshengzhuo2001@163.com Zhongshan Hospital, Fudan Univeristy Nephrology Shanghai China -

Co-author 15

Introduction

The study aims to investigate the association between dialysis shift and all-cause death and hospitalization among patients on hemodialysis (HD).

Methods

In this single-center retrospective analysis, we enrolled 395 patients on HD who received treatment at our center on June 1, 2022, with a 2-year follow-up period. Participants were grouped into three dialysis shifts: morning-shift, afternoon-shift, and night-shift. The primary outcome was all-cause mortality. The secondary outcome was hospitalizations and the association between hospitalization and clinical parameters.

Results

395 patients were analyzed for all-cause mortality. Kaplan-Meier analysis revealed a significantly elevated mortality among afternoon-shift patients compared to other shift groups (P=0.013). Multivariable Cox regression confirmed that afternoon-shift was independently associated with an increased risk of mortality (adjusted HR 1.697, 95% CI 1.028-2.804). During a follow-up of two years, the remaining 272 surviving patients were evaluated for hospitalization events. The total number of hospitalization events and hospitalization per person-year were significantly lower in the night-shift group compared to other shifts. Furthermore, this group demonstrated the lowest incidence of access-related/HD-related hospitalization. Subsequent analyses identified: (1) negative association between SpKt/V and non-access-related events; (2) negative association between serum calcium and all-cause hospitalization; (3) negative correlation between left ventricular ejection fraction and access-related/HD-related events.

Conclusion

Dialysis shift is associated with all-cause mortality and hospitalizations among patients on HD. However, this relationship is not directly driven by the temporal effects of the shift but rather by the fact that individuals with similar clinical characteristics tend to choose the same shift, leading to shift-specific differences in health outcomes.

Kewords