RELATIONSHIP BETWEEN TIMING OF HEMODIALYSIS AND PROCEDURE RELATED HEMODYNAMIC DISTURBANCES DURING ENDOSCOPY IN PATIENTS WITH ESRD

Background: There is a growing population of patients with end-stage renal disease (ESRD) on hemodialysis (HD) in the United States who frequently require screening or diagnostic and therapeutic endoscopic procedures. While literature supports timing general surgery procedures one day following HD sessions, there is inadequate data on optimal timing of endoscopic procedures following HD. In this study, we examined the peri- and postoperative complications related to endoscopies performed the same day as compared to 1-2 days following HD.

Methods: A retrospective database of patients with ESRD on HD who underwent endoscopic procedures at a single institution from 2016-2022 was analyzed based on timing of procedures in relation to last HD session. Peri- and post-procedure complications were summarized and analyzed for differences based on timing using Chi-squared analysis for frequencies and T-test analysis for means.

Results: 256 patients with ESRD on a thrice weekly HD schedule underwent endoscopic procedures over a seven-year period among which 51 patients had procedures on the same day following last HD session and 205 patients had procedures 1-2 days following last HD session. No significant differences in patient or procedure characteristics were noted between these two groups. One patient in the same day dialysis group had an intra-operative cardiac (2.0% vs. 0% for 0 vs. 1-2 days post-HD, respectively; p = 0.04). No differences were observed in arrhythmias, intra-operative bleeding, post-procedural ICU admission, intraoperative administration of fluids, phenylephrine, and second pressors. Higher rates of in-hospital (7.8% vs. 2.0%, p = 0.03) and 30-day mortality (11.8% vs. 2.9%, p = 0.01) were observed 0 days as compared to 1-2 days post-HD.

Conclusions: Endoscopic procedures performed on the same day following HD may be associated with a higher risk for cardiac arrests, in-hospital mortality, and 30-day mortality. Likely mechanism driving this increased cardiovascular risk include rapid fluid shifts that lead to myocardial stress and electrolyte derangements that potentiate arrhythmias. These findings suggest timing elective endoscopic procedures 1-2 days following HD.