Seasonal variation in hemodialysis initiation: A single-center retrospective analysis

Abstract

The number of new dialysis patients has been increasing worldwide, particularly among elderly individuals. However, information on seasonal variation in hemodialysis initiation in recent decades is lacking, and the seasonal distribution of patients' conditions immediately prior to starting dialysis remains unclear. Having this information could help in developing a modifiable approach to improving pre-dialysis care. We retrospectively investigated the records of 297 patients who initiated hemodialysis at Hiroshima Prefectural Hospital from January 1st, 2009 to December 31st, 2013. Seasonal differences were assessed by χ 2 orKruskal-Wallis tests. Multiple comparison analysis was performed with the Steel test. The overall number of patients starting dialysis was greatest in winter (n = 85, 28.6%), followed by spring (n = 74, 24.9%), summer (n = 70, 23.6%), and autumn (n = 68, 22.9%), though the differences were not significant. However, there was a significant winter peak in dialysis initiation among patients aged !65 years, but not in those aged <65 years. Fluid overload assessed by clinicians was the most common uremic symptom among all patients, but a winter peak was only detected in patients aged !65 years. The body weight gain ratio showed a similar trend to fluid overload assessed by clinicians. Pulmonary edema was most pronounced in winter among patients aged !65 years compared with other seasons. The incidences of infection were modestly increased in summer and winter, but not statistically significant. Cardiac complications were similar in all seasons. This study demonstrated the existence of seasonal variation in dialysis initiation, with a winter peak among patients aged !65 years. The winter increment in dialysis initiation was mainly attributable to increased fluid overload. These findings suggest that elderly individuals should be monitored particularly closely during the winter.

Seasonal variations in cause-specific mortality and transition to renal replacement therapy among patients with end-stage renal disease

“…The initiation of HD was highest in the winter and lowest in the summer, whereas seasonal variations in the initiation of PD and the transition to KTx were not similar to HD in our study. These results are consistent with previous studies 7,12,13 . Although the reason why the initiation of HD was highest in the winter remains unclear, acute kidney injury induced by heart failure, coronary artery disease, and infectious pneumonia may partially contribute to the seasonal variation in the initiation of HD.…”

“…However, the seasonal variation in the mortality from each disease in patients with end-stage renal disease (ESRD) remains unclear, although some studies have investigated the seasonal variations in all-cause mortality or mortality from cardiovascular disease (CVD), infectious disease, or cancer [7][8][9][10] . In addition, because the mortality rate in patients with ESRD is substantially higher and the distribution of cause of death differs 11 , the results in the general population should not be extrapolated to ESRD. There is also a lack in studies investigating the seasonal variation in the transition to renal replacement therapy (RRT) 7,12,13 . Two Japanese studies have shown that the number of initiation of dialysis was largest in the winter 12,13 .…”

“…In addition, because the mortality rate in patients with ESRD is substantially higher and the distribution of cause of death differs 11 , the results in the general population should not be extrapolated to ESRD. There is also a lack in studies investigating the seasonal variation in the transition to renal replacement therapy (RRT) 7,12,13 . Two Japanese studies have shown that the number of initiation of dialysis was largest in the winter 12,13 . However, the sample size was relatively small, and these studies did not investigate peritoneal dialysis (PD) and kidney transplantation (KTx).…”

Seasonal variation in emergent hemodialysis initiation in the late elderly: A single‐center study

“…There are few studies on the seasonal variation of dialysis initiation. [7][8][9][10] Only one study has reported a significant winter peak in hemodialysis initiation among patients aged ≥75 years. 10 By dividing elderly patients aged ≥65 years into the early elderly and late elderly groups, we have shown that it is not the early elderly group but the late elderly group who has a significant winter peak in hemodialysis initiation.…”

“…[3][4][5][6] However, few studies have reported seasonal variations in dialysis initiation. [7][8][9][10] Among them, only one study has reported a significant winter peak in hemodialysis initiation among patients aged ≥75 years. 10 Emergent initiation of hemodialysis is an independent risk factor for morbidity and mortality among patients with end-stage kidney disease.…”