Effect of Missed Dialysis Sessions on Short Term Cardiovascular Events

March 12, 2026 updated by: Amna Abdelnasser Taher, Assiut University
the effect of missed hemodialysis sessions on the occurrence of short-term cardiovascular events in patients with end-stage renal disease receiving maintenance hemodialysis.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

End-stage renal disease (ESRD) represents a major and growing global health burden, with a steadily increasing prevalence worldwide. Patients receiving maintenance hemodialysis (HD) experience markedly elevated rates of cardiovascular morbidity and mortality compared with the general population (1).

Cardiovascular disease accounts for nearly half of all deaths among HD patients, reflecting the combined effects of traditional cardiovascular risk factors and dialysis-specific stressors, including large volume shifts, electrolyte disturbances, chronic inflammation, and autonomic dysfunction (2).

Maintenance HD is designed to preserve physiological homeostasis through regular removal of excess fluid, electrolytes, and uremic toxins. Adherence to the prescribed dialysis schedule is therefore essential for maintaining cardiovascular stability (3).

Despite its life-sustaining role, HD is an inherently complex and time-consuming therapy, typically delivered three times weekly for several hours per session. This demanding regimen imposes substantial physical, psychological, and socioeconomic burdens on patients and contributes to persistently high rates of hospitalization and mortality (4).

Missed HD sessions or delays in treatment represent a common and clinically significant challenge in routine dialysis care, with observational studies indicating that 515% of patients miss at least one scheduled session annually. Disruption of the regular dialysis schedule results in prolonged interdialytic intervals and loss of metabolic and volume control (5).

Importantly, missed treatments are not solely attributable to patient nonadherence. A wide range of contributing factors has been identified, including logistical barriers such as unreliable transportation, long travel times to dialysis units, adverse weather conditions, and scheduling of sessions on weekends or holidays. Medical factors such as gastrointestinal symptoms, vascular access dysfunction, chronic pain, depression, and substance use further contribute to treatment nonattendance. Additionally, demographic and psychosocial factors, including older age, limited health literacy, race or ethnicity, and lack of social or marital support, play an important role (6).

The consequences of missed HD sessions extend beyond inadequate solute clearance. Prolonged interdialytic intervals lead to acute physiological derangements, including progressive fluid overload, worsening hypertension, hyperkalemia, metabolic acidosis, and accumulation of uremic toxins. These abnormalities impose significant myocardial stress and increase electrical instability (7).

The cardiovascular system of HD patients is particularly vulnerable to abrupt changes in preload and afterload. Excess interdialytic weight gain following missed sessions increases cardiac workload and predisposes patients to acute heart failure decompensation. Concurrently, electrolyte disturbances particularly hyperkalemia may precipitate malignant arrhythmias, while autonomic imbalance and heightened sympathetic activity further amplify the risk of sudden cardiac events (8).

Consistent with these pathophysiological mechanisms, studies comparing scheduled dialysis days have demonstrated higher rates of cardiovascular events following longer interdialytic gaps. Moreover, skipped treatments have been associated with sharply increased short-term risks of hospitalization and mortality, particularly within 4872 hours the missed session (9).

Additionally, Missed HD sessions have also been linked to unfavorable anemia-related outcomes, including lower hemoglobin levels and increased requirements for erythropoiesafteris-stimulating agents, further reflecting compromised dialysis adequacy

Study Type

Observational

Enrollment (Estimated)

225

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Egypt
    • Assiut Governorate
      • Asyut, Assiut Governorate, Egypt
        • Assiut University hospital
        • Contact:
        • Principal Investigator:
          • Amna A Taher, Resident

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

Hemodialysis Unit of Internal Medicine Department

Description

Inclusion Criteria:

  • Adult patients aged ≥18 years.
  • Patients diagnosed with end-stage renal disease (ESRD).
  • Patients receiving maintenance hemodialysis on a regular schedule (three sessions per week).
  • Patients on maintenance hemodialysis for at least 3 months prior to enrolment.

Exclusion Criteria:

  • Patients receiving peritoneal dialysis or other forms of renal replacement therapy.
  • Patients with acute kidney injury requiring temporary dialysis.
  • Patients with documented acute cardiovascular events within 30 days prior to study enrolment.
  • Patients who undergo renal transplantation during the study period.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incidence of short-term cardiovascular events (CVE) following missed hemodialysis sessions
Time Frame: 1 year
Short-term cardiovascular events will be defined as the occurrence of acute coronary syndrome, acute decompensated heart failure, documented arrhythmias, sudden cardiac death, or cerebrovascular events occurring within 72 hours after a missed hemodialysis session.
1 year

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Assiut University

Investigators

  • Principal Investigator: Mohamed Ali Touhami Ibrahim, Professor
  • Principal Investigator: Eman Mohamed Ibrahim Kamed Hussain, Assistant lecture

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

October 1, 2026

Primary Completion (Estimated)

October 1, 2027

Study Completion (Estimated)

December 1, 2027

Study Registration Dates

First Submitted

March 3, 2026

First Submitted That Met QC Criteria

March 3, 2026

First Posted (Actual)

March 6, 2026

Study Record Updates

Last Update Posted (Actual)

March 16, 2026

Last Update Submitted That Met QC Criteria

March 12, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Missed HD sessions

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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