Seasonal and Secular Trends of Cardiovascular, Nutritional, and Inflammatory Markers in Patients on Hemodialysis

Abstract

Background All life on earth has adapted to the effects of changing seasons. The general and ESKD populations exhibit seasonal rhythms in physiology and outcomes. The ESKD population also shows secular trends over calendar time that can convolute the influences of seasonal variations. We conducted an analysis that simultaneously considered both seasonality and calendar time to isolate these trends for cardiovascular, nutrition, and inflammation markers. Methods We used data from adult patients on hemodialysis (HD) in the United States from 2010 through 2014. An additive model accounted for variations over both calendar time and time on dialysis. Calendar time trends were decomposed into seasonal and secular trends. Bootstrap procedures and likelihood ratio methods tested if seasonal and secular variations exist. Results We analyzed data from 354,176 patients on HD at 2436 clinics. Patients were 59615 years old, 57% were men, and 61% had diabetes. Isolated average secular trends showed decreases in pre-HD systolic BP (pre-SBP) of 2.6 mm Hg (95% CI, 2.4 to 2.8) and interdialytic weight gain (IDWG) of 0.35 kg (95% CI, 0.33 to 0.36) yet increases in post-HD weight of 2.76 kg (95% CI, 2.58 to 2.97). We found independent seasonal variations of 3.3 mm Hg (95% CI, 3.1 to 3.5) for pre-SBP, 0.19 kg (95% CI, 0.17 to 0.20) for IDWG, and 0.62 kg (95% CI, 0.46 to 0.79) for post-HD weight as well as 0.12 L (95% CI, 0.11 to 0.14) for ultrafiltration volume, 0.41 ml/kg per hour (95% CI, 0.37 to 0.45) for ultrafiltration rates, and 3.30 (95% CI, 2.90 to 3.77) hospital days per patient year, which were higher in winter versus summer. Conclusions Patients on HD show marked seasonal variability of key indicators. Secular trends indicate decreasing BP and IDWG and increasing post-HD weight. These methods will be of importance for independently determining seasonal and secular trends in future assessments of population health.

A phase 3b, multicenter, open‐label, single‐arm study of roxadustat within a US dialysis organization: The DENALI study

“…In the majority of patients, the roxadustat dosing algorithm achieved and/or maintained Hb at target. The influences of Hb cycling 34 and the effects of seasonality 35 are also anticipated and can influence the need for dose titration over time. Nonetheless, when considering the time in range for Hb levels within 10–12 g/dL, roxadustat use in the present study appeared consistent with injectable ESAs reported previously.…”

The Role of Cold Exposure on Ischemic Heart Disease: A Systematic Review

“…According to one theory, being exposed to low temperatures causes a rapid release of catecholamines, which in turn causes increases in platelet aggregability, vasomotor tone, hemodynamic parameters, and other hematological and endothelial parameters. When a person comes from warm indoor to cold circumstances, the resultant increase in heart workload and oxygen consumption may precipitate an ACS [30,31].…”