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

Maeoka Yujiro

Naito Takayuki

Irifuku Taisuke

Shimizu Yuka

Ogawa Takahiko

Masaki Takao

PLoS ONE

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 χ2 or Kruskal-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.

eng

Public Library of Science

© 2017 Maeoka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

[ISSN] 1932-6203

[DOI] 10.1371/journal.pone.0178967

[DOI] https://doi.org/10.1371/journal.pone.0178967