Abstract
BackgroundIncreased left ventricular mass (LVM) is associated with adverse outcomes in patients receiving chronic hemodialysis. Among patients receiving conventional hemodialysis (CHD, 3×/week, 4 hrs/session), we evaluated whether dialysis intensification with in-centre nocturnal hemodialysis (INHD, 3×/week, 7-8 hrs/session in the dialysis unit) was associated with regression of LVM.MethodsWe conducted a retrospective cohort study of CHD recipients who converted to INHD and received INHD for at least 6 months. LVM on the first echocardiogram performed at least 6 months post-conversion was compared to LVM pre-conversion. In a secondary analysis, we examined echocardiograms performed at least 12 months after starting INHD. The effect of conversion to INHD on LVM over time was also evaluated using a longitudinal analysis that incorporated all LVM data on patients with 2 or more echocardiograms.ResultsThirty-seven patients were eligible for the primary analysis. Mean age at conversion was 49 ± 12 yrs and 30% were women. Mean pre-conversion LVM was 219 ± 66 g and following conversion, LVM declined by 32 ± 58 g (p = 0.002). Among patients whose follow-up echocardiogram occurred at least 12 months following conversion, LVM declined by 40 ± 56 g (p = 0.0004). The rate of change of LVM decreased significantly from 0.4 g/yr before conversion, to -11.7 g/yr following conversion to INHD (p < 0.0001).ConclusionConversion to INHD is associated with a significant regression in LVM, which may portend a more favourable cardiovascular outcome. Our preliminary findings support the need for randomized controlled trials to definitively evaluate the cardiovascular effects of INHD.
Highlights
Increased left ventricular mass (LVM) is associated with adverse outcomes in patients receiving chronic hemodialysis
In a recent randomized controlled trial, home nocturnal HD (5-6 sessions per week, 7-8 hours per session) conferred a regression in left ventricular mass (LVM), a well-validated surrogate for clinical events, as compared to individuals who remained on conventional HD (CHD) [7]
Only a minority of CHD patients is capable of undertaking home nocturnal HD and these benefits of intensified HD may not be available to the majority of the conventional HD population
Summary
Increased left ventricular mass (LVM) is associated with adverse outcomes in patients receiving chronic hemodialysis. Among patients receiving conventional hemodialysis (CHD, 3×/week, 4 hrs/session), we evaluated whether dialysis intensification with in-centre nocturnal hemodialysis (INHD, 3×/week, 7-8 hrs/session in the dialysis unit) was associated with regression of LVM. Interventions that have been shown to improve cardiovascular outcomes in the general population have inconsistently demonstrated benefit in patients receiving chronic dialysis [2,3,4,5]. This may be, in part, due to the unique array of cardiovascular risk factors in patients with end-stage renal disease (ESRD)[6]. Only a minority of CHD patients is capable of undertaking home nocturnal HD and these benefits of intensified HD may not be available to the majority of the conventional HD population
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