Effect of Missed Dialysis Sessions on Short Term Cardiovascular Events

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).