Bleyer A J, Russell G B, Satko S G
Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Kidney Int. 1999 Apr;55(4):1553-9. doi: 10.1046/j.1523-1755.1999.00391.x.
Sudden and cardiac death (including death from congestive heart failure, myocardial infarction, and sudden death) are common occurrences in hemodialysis patients. The intermittent nature of hemodialysis may lead to an uneven distribution of sudden and cardiac death throughout the week. The purpose of this study was to assess the septadian rhythm of sudden and cardiac death in hemodialysis patients.
Data from the United States Renal Data System (USRDS) were obtained to examine the day of death for United States hemodialysis and peritoneal dialysis patients from 1977 through 1997. The days of death were also determined for patients in the Case Mix Adequacy Study of the USRDS.
There was an even distribution of sudden and cardiac deaths for patients on peritoneal dialysis, and hemodialysis patients dying of noncardiac deaths also had an even distribution. For all hemodialysis patients, Monday and Tuesday were the most common days of sudden and cardiac death. For patients in the Case Mix Adequacy Study designated as Monday, Wednesday, and Friday dialysis patients, 20.8% of sudden deaths occurred on Monday compared 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 trends were found on Tuesday for Tuesday, Thursday, and Saturday dialysis patients.
The intermittent nature of hemodialysis may contribute to an increased sudden and cardiac death rate on Monday and Tuesday for patients enrolled in the USRDS.
猝死和心源性死亡（包括死于充血性心力衰竭、心肌梗死和猝死）在血液透析患者中很常见。血液透析的间歇性可能导致猝死和心源性死亡在一周内分布不均。本研究的目的是评估血液透析患者猝死和心源性死亡的七日节律。
获取美国肾脏数据系统（USRDS）的数据，以检查1977年至1997年美国血液透析和腹膜透析患者的死亡日期。还确定了USRDS病例组合充分性研究中患者的死亡日期。
腹膜透析患者的猝死和心源性死亡分布均匀，死于非心源性死亡的血液透析患者的死亡分布也均匀。对于所有血液透析患者，周一和周二是猝死和心源性死亡最常见的日子。在病例组合充分性研究中被指定为周一、周三和周五进行透析的患者中，20.8%的猝死发生在周一，而预期为14.3%（P = 0.002）。同样，20.2%的心源性死亡发生在周一，而预期为14.3%（P = 0.0005）。在周二进行透析的患者中，周二、周四和周六进行透析的患者也发现了类似趋势。
血液透析的间歇性可能导致USRDS登记患者在周一和周二的猝死和心源性死亡率增加。
