Relationship Between Timing of Hemodialysis and Procedure-Related Complications Following Endoscopy in Patients with End-Stage Renal Disease

Abstract

Purpose: There is a growing population of patients with end-stage renal disease (ESRD) on hemodialysis (HD) requiring endoscopic procedures. While literature supports timing general surgeries one day following dialysis, there is inadequate data on optimal timing of endoscopic procedures. This study examined the procedural complications related to endoscopic procedures based on timing post-HD.

Methods: This retrospective cohort study included endoscopic procedures in patients with ESRD on thrice-weekly HD at a single institution. Procedural complications were analyzed using a GEE model incorporating inverse probability treatment weighting logistic regression based on pre-procedural covariates (Model 1) and combined pre- and intra-procedural covariates (Model 2).

Results: 252 procedures were identified in 191 unique patients, among which 48, 147 and 57 were performed 0, 1 and 2 days post-HD, respectively. Procedures performed on the same day post-HD were more likely to be inpatient (n = 44, 91.7% vs. n = 101, 68.7% vs. n = 39, 68.4% for 0 vs. 1 vs. 2 days post-HD, respectively; p = 0.005) with indication for GI bleeding and/or anemia (n = 40, 83.3% vs. n = 95, 64.6% vs. n = 42, 73.7% for 0 vs. 1 vs. 2 days post-HD, respectively; p = 0.04). Patients undergoing procedures 0 compared to 1-2 days post-HD were more likely to experience mortality (Model 1 OR 2.91, 95% CI 1.24-6.80; p = 0.01; Model 2 OR 3.22, 95% CI 1.42-7.29, p = 0.005).

Conclusion: Endoscopic procedures performed on the same day following HD may be associated with a higher risk for mortality. Further studies are needed to reproduce these findings and explore the underlying mechanisms driving this association.

Keywords: Endoscopy; Hemodialysis; Procedural complications; Timing.