Table 1.

Selected studies of the day-of-week dialysis schedule and outcomes in hemodialysis patients.

Author (Year)	Study Population (N)	Outcome	Findings
Bleyer et al. (1999)¹⁴	HD and PD patients from USRDS. (N=375,482 death events; US)	Sudden death, cardiac death.	• Sudden and cardiac deaths most common on Mondays and Tuesdays in HD patients. • Higher rate of deaths on Mondays among patients on MWF schedule vs. Tuesdays among patients on TTS schedule. • Even distribution of events across weekdays amongst PD patients.
Karnik et al. (2001)¹⁵	HD patients from national LDO. (N >77,000; US)	In-center cardiac arrest.	• Cardiac arrest most frequent on Monday vs. other days of week (among patients on MWF schedule). • No day of week effect observed among patients on TTS schedule. • 7%, 81%, and 12% events occurred immediately preceding, during, and following treatments prior to leaving dialysis unit.
Bleyer et al. (2006)¹⁶	HD patients from five centers in SE US. (N=80 patients with sudden cardiac death; US)	Sudden cardiac death.	• Death events more common in the last 12 hours of long interdialytic gap prior to dialysis and during the first 12 hours immediately after dialysis (bimodal death distribution).
Foley et al. (2011)¹⁷	HD patients from the ESRD Clinical Performance Measures Project. (N= 32,065; US)	Mortality due to all-cause, CV, infection, CV arrest, and MI. Hospitalization due to MI, CHF, CVA, dysrhythmia, and any CV event.	• Higher mortality and hospitalization (all causes) the day after the long interdialytic gap. • Subgroup of patients with less than 1 year of prior dialysis treatment, unlike the overall study population, did not have higher-than expected mortality after the long interdialytic interval.
Zhang et al. (2012)¹⁸	HD patients from DOPPS cohort. (N=22,163; US, Japan, Europe)	Mortality.	• Higher mortality after the long interdialytic gap among US, Japanese, and European patients. • Highest mortality seen on last HD session of the week: ▪ Japanese patients on MWF schedule had highest risk of non-CV mortality on Friday. ▪ European patients on TTS schedule had highest risk of CV mortality on Saturday.
Fotheringham et al. (2015)¹⁹	HD patients from UK Renal Registry. (N=5864; UK)	Mortality, hospitalizations.	• Higher hospitalization rates the day after the long interdialytic gap across all treatment schedules (MWF, TTS, TTSun). • Higher mortality rates that day after the long interdialytic gap across all treatment schedules, largely due to out-of-hospital deaths.
Roy- Chaudhury et al. (2018)^5,20	HD patients from the Monitoring in Dialysis study. (N=66; US, India)	Clinically significant arrhythmias.	• Highest rates of clinically significant arrhythmias during the first dialysis session of the week and the last 12 hours of the long interdialytic interval.

Abbreviations: HD, hemodialysis; PD, peritoneal dialysis; USRDS, United States Renal Data System; US, United States; MWF, Monday-Wednesday-Friday; TTS, Tuesday-Thursday-Saturday; PD, peritoneal dialysis; LDO, large dialysis organization; SE, southeast; ESRD, end-stage renal disease; CV, cardiovascular; MI, myocardial infarction; CHF, congestive heart failure; CVA, cerebrovascular accident; DOPPS, Dialysis Outcomes Practice Patterns; UK, United Kingdom; TTSun, Tuesday-Thursday-Sunday.