Survival by Time of Day of Hemodialysis in Korean Patients: A Single Center Study

Background: Patients with end-stage renal disease (ESRD) typically undergo hemodialysis (HD) during the morning or afternoon, with time of treatment generally based on space availability or patient preference. No studies have investigated variation in patient survival as a function of the time of day of dialysis in Korean HD patients. We investigated the association of patient HD treatment shift with continued survival, controlling for well-established HD-related mortality risk factors.
Method: A 10-year (from January 1, 2001 to December 31, 2010) follow-up retrospective cohort study was conducted among 120 ESRD patients who underwent HD at Kosin University Gospel Hospital either during a morning shift (n = 60) or an afternoon shift (n = 60). A variable comparison was conducted using a Chi-square test and t-test for categorical and continuous variables, respectively. Life table analysis was used to compare survival rates in the two treatment groups.
Results: The mean survival rate of the morning-shift HD patients and afternoon-shift HD patients were not statistically different (mean survival, 61.1 months vs. 48.2 months; P = 0.139). The unadjusted 5-year survival rate for patients on morning shift hemodialysis was 87.3% versus 86.4% for patients on afternoon shift hemodialysis (P = 0.704 by Wilcoxon test).
Conclusions: The survival rates of morning-shift HD patients and afternoon-shift HD patients were not different. Results from this cohort study may warrant prospective observational studies and randomized clinical trials in Korean HD patients for whom the time of day at which HD is administered is systemically varied.