Circadian variation of death in hemodialysis patients.

@article{citeulike:2283345, abstract = {BACKGROUND: There is a circadian variation of death in nondialysis populations, with more cardiovascular events occurring in the morning. Whether this holds true in hemodialysis patients was never investigated. STUDY DESIGN: Case series. SETTING \& PARTICIPANTS: All prevalent (>3 months on hemodialysis therapy) and incident (<or=3 months on hemodialysis therapy) patients of a dialysis network followed up prospectively for 18 months. PREDICTORS: Patient characteristics and circumstances of death. OUTCOMES \& MEASUREMENTS: Time of death. Data for time of death were collected within 72 hours of the event. The frequency of deaths occurring in the morning hours (4:01 am to 12:00 noon) was compared with that expected by chance alone. RESULTS: Time of death could be defined in 873 of 927 deaths (94.2\%). In 459 prevalent hemodialysis patients, morning deaths occurred 24.8\% more frequently than expected (P < 0.001). No similar excess was observed in the 414 incident hemodialysis patients (P = 0.9). In logistic regression, significant predictors of death occurring from 4:01 am to 12:00 noon in all subjects were being an outpatient (odds ratio [OR], 1.89; 95\% confidence interval [CI], 1.24 to 2.88) and time since the end of the last dialysis treatment (postdialysis 49- to 72-hour period: OR, 1.73 [95\% CI, 1.13 to 2.64] compared with 1 to 24 hours postdialysis). Considering prevalent hemodialysis patients only, being an outpatient (OR, 1.93; 95\% CI, 1.17 to 3.18), postdialysis 25- to 48- and 49- to 72-hour periods (OR, 1.68; 95\% CI, 1.05 to 2.68 and OR, 1.80; 95\% CI, 1.03 to 3.12), diabetes (OR, 1.73; 95\% CI, 1.14 to 2.63]), and beta-blocker use (OR, 1.62; 95\% CI, 1.08 to 2.43) were directly related and the presence of medical symptoms during the last dialysis treatment (OR, 0.53; 95\% CI, 0.34 to 0.83) was inversely related to the risk of morning death. LIMITATIONS: No information for causes of deaths was gathered. CONCLUSIONS: Prevalent hemodialysis patients have an excess of morning deaths, and its predictors suggest potential avenues for intervention studies.}, address = {B. Braun Avitum Nephrological Network, Budapest, Hungary. atisler1@t-online.hu}, author = {Tisl\'{e}r, A. and Logan, A. G. and Ak\'{o}csi, K. and Torn\'{o}ci, L. and Kiss, I.}, citeulike-article-id = {2283345}, doi = {10.1053/j.ajkd.2007.09.019}, issn = {1523-6838}, journal = {Am J Kidney Dis}, keywords = {diurnal, hd, mortality}, month = {January}, number = {1}, pages = {53--61}, posted-at = {2008-01-24 05:45:01}, priority = {2}, title = {Circadian variation of death in hemodialysis patients.}, url = {http://dx.doi.org/10.1053/j.ajkd.2007.09.019}, volume = {51}, year = {2008} }

TY - JOUR ID - citeulike:2283345 L3 - citeulike-article-id:2283345 N2 - BACKGROUND: There is a circadian variation of death in nondialysis populations, with more cardiovascular events occurring in the morning. Whether this holds true in hemodialysis patients was never investigated. STUDY DESIGN: Case series. SETTING & PARTICIPANTS: All prevalent (>3 months on hemodialysis therapy) and incident (<or=3 months on hemodialysis therapy) patients of a dialysis network followed up prospectively for 18 months. PREDICTORS: Patient characteristics and circumstances of death. OUTCOMES & MEASUREMENTS: Time of death. Data for time of death were collected within 72 hours of the event. The frequency of deaths occurring in the morning hours (4:01 am to 12:00 noon) was compared with that expected by chance alone. RESULTS: Time of death could be defined in 873 of 927 deaths (94.2%). In 459 prevalent hemodialysis patients, morning deaths occurred 24.8% more frequently than expected (P < 0.001). No similar excess was observed in the 414 incident hemodialysis patients (P = 0.9). In logistic regression, significant predictors of death occurring from 4:01 am to 12:00 noon in all subjects were being an outpatient (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.24 to 2.88) and time since the end of the last dialysis treatment (postdialysis 49- to 72-hour period: OR, 1.73 [95% CI, 1.13 to 2.64] compared with 1 to 24 hours postdialysis). Considering prevalent hemodialysis patients only, being an outpatient (OR, 1.93; 95% CI, 1.17 to 3.18), postdialysis 25- to 48- and 49- to 72-hour periods (OR, 1.68; 95% CI, 1.05 to 2.68 and OR, 1.80; 95% CI, 1.03 to 3.12), diabetes (OR, 1.73; 95% CI, 1.14 to 2.63]), and beta-blocker use (OR, 1.62; 95% CI, 1.08 to 2.43) were directly related and the presence of medical symptoms during the last dialysis treatment (OR, 0.53; 95% CI, 0.34 to 0.83) was inversely related to the risk of morning death. LIMITATIONS: No information for causes of deaths was gathered. CONCLUSIONS: Prevalent hemodialysis patients have an excess of morning deaths, and its predictors suggest potential avenues for intervention studies. IS - 1 JF - Am J Kidney Dis SN - 1523-6838 AD - B. Braun Avitum Nephrological Network, Budapest, Hungary. atisler1@t-online.hu EP - 61 TI - Circadian variation of death in hemodialysis patients. VL - 51 SP - 53 KW - diurnal KW - hd KW - mortality AU - Tislér, A AU - Logan, AG AU - Akócsi, K AU - Tornóci, L AU - Kiss, I PY - 2008/01// UR - http://dx.doi.org/10.1053/j.ajkd.2007.09.019 ER -