Survival by time of day of hemodialysis: analysis of United States renal data system dialysis morbidity and mortality waves III/IV Kevin C Abbott, MD,

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Survival by time of day of hemodialysis: analysis of United States renal data system dialysis morbidity and mortality waves III/IV Kevin C Abbott, MD, Joel C Reynolds, MD, Fernando C Trespalacios, MD, David Cruess, PhD, Lawrence Y Agodoa, MD American Journal of Kidney Diseases Volume 41, Issue 4, Pages 796-806 (April 2003) DOI: 10.1016/S0272-6386(03)00027-1 Copyright © 2003 Terms and Conditions

Fig 1 Kaplan-Meier survival curves showing unadjusted patient survival by time of day of hemodialysis for entire cohort, DMMS Waves III/IV patients who started hemodialysis on or after January 1, 1990 (N = 6,325) with nonnegative survival times. Study start was December 31, 1993, followed up until April 9, 2000. 1 = Evening shift hemodialysis (1800 to midnight), 2 = morning shift (0500 to 1200), 3 = afternoon shift (1200 to 1800), and 4 = unknown shift. Both morning shift and evening shift hemodialysis were associated with significantly lower mortality compared with afternoon shift hemodialysis in Cox regression (see Table 3). *P < 0.001 versus afternoon shift hemodialysis by log-rank test. American Journal of Kidney Diseases 2003 41, 796-806DOI: (10.1016/S0272-6386(03)00027-1) Copyright © 2003 Terms and Conditions

Fig 2 Kaplan-Meier survival curves showing unadjusted patient survival by time of day of hemodialysis, limited to patients 60 years or older. 1 = Evening shift hemodialysis (1800 to midnight), 2 = morning shift (0500 to 1200), 3 = afternoon shift (1200 to 1800), and 4 = unknown shift. Both morning shift and evening shift were independently associated with reduced mortality compared with afternoon shift hemodialysis (see Table 4). *P < 0.001 versus afternoon shift hemodialysis by log-rank test. American Journal of Kidney Diseases 2003 41, 796-806DOI: (10.1016/S0272-6386(03)00027-1) Copyright © 2003 Terms and Conditions

Fig 3 Kaplan-Meier survival curves showing unadjusted patient survival by time of day of hemodialysis, limited to patients younger than 60 years. 1 = Evening shift hemodialysis (1800 to midnight), 2 = morning shift (0500 to 1200), 3 = afternoon shift (1200 to 1800), and 4 = unknown shift. There were no significant differences in survival by time of day of hemodialysis. In Cox regression analysis, the adjusted hazard ratio for morning shift hemodialysis (2) versus afternoon shift hemodialysis (3) was 0.88 (95% CI, 0.75 to 1.04; P = 0.12). The adjusted hazard ratio for evening shift hemodialysis (1) versus afternoon shift hemodialysis (3) was 0.80 (95% CI, 0.57 to 1.13; P = 0.20). American Journal of Kidney Diseases 2003 41, 796-806DOI: (10.1016/S0272-6386(03)00027-1) Copyright © 2003 Terms and Conditions