Effect of Time of Day of Dialysis Shift on Serum Biochemical Parameters in Patients on Chronic Hemodialysis

Abstract

It is unknown whether predialysis serum biochemical parameters may differ among chronic hemodialysis patients depending on the shift during which they are dialyzed. We studied 115 patients on chronic hemodialysis in our institution for 3 consecutive months and compared clinical and biochemical parameters based on the shift during which they were dialyzed. Predialysis serum potassium was found to be progressively higher for patients dialyzed on later as compared with earlier dialysis shifts, and phosphate was significantly higher for patients dialyzed during the evening shift as well. Regression analysis suggested that higher potassium and phosphate levels were related to the time of day of these sessions and not to patient age, amount of dialysis given or diet. By contrast, serum albumin, creatinine, sodium, and chloride levels were found to differ depending on dialysis shift, though these differences appeared to be accounted for by patient age. We conclude that the time of day of the beginning of the dialysis shift appears to mildly influence the levels of serum predialysis biochemical parameters which are important in monitoring patients on chronic hemodialysis, in particular potassium and phosphate. Further insight into the mechanism of this observed effect might improve our ability to interpret and treat derangements of these serum biochemical parameters in patients on chronic hemodialysis.

Survival by Time of Day of Hemodialysis in an Elderly Cohort

“…For example, biochemical clearance may be optimized during morning-shift HD. In a group of 124 patients representing 4 shifts, Mattana et al 12 reported that HD patients who were dialyzed late in the day had relatively higher levels of potassium and phosphorus than those undergoing HD earlier in the day, implying less effective dialysis, perhaps owing to interaction with the evening meal. Although we did not have our population's laboratory data on hyperkalemia or hyperphosphatemia and therefore were unable to test this hypothesis, the possibility exists that some impairment of biochemical clearance might have hastened mortality in patients being dialyzed in the afternoon shift.…”

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

“…Third, biochemical clearance may be optimized during morning-shift HD. In a group of 124 patients representing four shifts, Mattana et al [12] reported that HD patients who were dialyzed late in the day had relatively higher levels of potassium and phosphorus than those undergoing HD earlier in the day, implying less effective dialysis, perhaps owing to interaction with the evening meal. Thus, the possibility exists that some impairment of biochemical clearance might have hastened mortality in patients being dialyzed in the afternoon shift.…”

Biomaterials for medical devices: Are current hemo‐ or biocompatibility tests adequate?

“…Many mechanical and physical engineers are surprised when they realise the enormous standard deviations -sometimes between 50 and 100% of data found in biological or physiological investigations of biomaterials. The reasons for this observation are the multi factorial complexity of physiological parameters, such as the nature of blood originating from a variety of donors and hour-to-hour [2], and day-to-day physiological differences which may depend on underlying diseases of either the blood donor or the clinical test person [3]. As a consequence, standardisation is a "conditio sine qua non" in biomaterial testing and knowledge of possible pitfalls is absolutely necessary.…”