Anemia and Blood Pressure Correction Obtained by Daily Hemodialysis Induce a Reduction of Left Ventricular Hypertrophy in Dialysed Patients

Rm, Fagugli; Buoncristiani, U; Ciao, Giovanni

doi:10.1177/039139889802100704

Cited by 49 publications

(25 citation statements)

References 2 publications

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“…Several uncontrolled studies of short daily hemodialysis (20,21) and nocturnal home hemodialysis (31) also have suggested reductions in LVH. However, to our knowledge, our study is the first to demonstrate a significant reduction in LVMI in a controlled manner comparing patients who received short daily hemodialysis or conventional hemodialysis in the setting of maximal guideline-based medical care.…”

Section: Discussionmentioning

confidence: 99%

Effects of Short Daily versus Conventional Hemodialysis on Left Ventricular Hypertrophy and Inflammatory Markers

Ayus

Mizani

Achinger

et al. 2005

Journal of the American Society of Nephrology

241

206

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Left ventricular hypertrophy (LVH) and inflammation independently increase risk for death in people who receive hemodialysis. A nonrandomized, controlled trial was conducted of the effect of short daily (6 sessions/wk of 3 h each) or conventional (three sessions/wk of 4 h each) hemodialysis on LVH and inflammatory factors. A total of 26 short daily hemodialysis and 51 matched conventional hemodialysis patients were enrolled, and baseline and 12-mo measures of echocardiographic left ventricular mass index (LVMI), serum C-reactive protein (CRP), serum calcium and phosphorus, and erythropoietin resistance index were collected. Baseline characteristics were similar between groups except that hemoglobin and serum calcium were lower and serum phosphorus was higher in the short daily hemodialysis group. At 12-mo follow-up, short daily hemodialysis patients experienced a 30% decrease in LVMI (154 ؎ 33 to 108 ؎ 25; P < 0.0001). After adjustment for potential confounders, short daily hemodialysis (␤ ‫؍‬ ؊41.63, P ‫؍‬ 0.03) and percentage decrease in serum phosphorus (␤ ‫؍‬ ؊0.12, P ‫؍‬ 0.04) predicted a 12-mo decrease in LVMI. Among short daily hemodialysis patients, there were significant reductions in median CRP levels [1.22 interquartile range (IQR) (0.37 to 3.70) to 0.05 IQR (0.05 to 1.17); P < 0.01] and erythropoietin resistance index [19.5 IQR (8.6 to 37.6) to 10.5 IQR (5.5 to 14.6); P < 0.001]. There were no significant changes in LVMI, CRP, or erythropoietin resistance index in the conventional hemodialysis group. Short daily hemodialysis is associated with improved fluid and phosphorus management and a reduction in LVH and inflammatory factors compared with conventional hemodialysis. Future trials are needed to determine whether short daily hemodialysis can reduce morbidity and mortality in this high-risk population.

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Section: Discussionmentioning

confidence: 99%

Effects of Short Daily versus Conventional Hemodialysis on Left Ventricular Hypertrophy and Inflammatory Markers

Ayus

Mizani

Achinger

et al. 2005

Journal of the American Society of Nephrology

241

206

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“…Decreases in systolic or mean arterial BP were reported in 10 of 11 studies (10,14,16,17,(22)(23)(24)27,29,31), whereas six of eight studies found no statistically significant change in phosphate or phosphate binder dose with DHD at 3 to 24 mo of follow-up (12,14,16,24,26,27). Health-related quality of life improved in some studies but not in others.…”

Section: Outcomes With Dhdmentioning

confidence: 97%

“…(14,16,17,19,24). One cohort was selected solely on the basis of medical indication (23), and indications were not specified for one cohort (22).…”

Section: Patient and Treatment Characteristicsmentioning

confidence: 99%

Daily Hemodialysis

Suri

Nesrallah

Mainra

et al. 2006

Clinical Journal of the American Society of Nephrology

172

145

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Several studies have reported improved outcomes with daily hemodialysis (DHD), but the strength of this evidence has not been evaluated. The published evidence on DHD was synthesized and its quality rated to inform need and sample size calculations for a randomized trial. Citations were identified in MEDLINE and EMBASE using validated search strategies. Dialysis journals that were not indexed and bibliographies of relevant articles were hand-searched. Two authors reviewed all citations. Articles that reported original data on five or more adults who were receiving DHD (1.5 to 3 h, 5 to 7 d/wk) for >3 mo were included. Twenty-five articles reporting 14 unique populations with 268 patients (five to 72 per study) met inclusion criteria. Of the 14 cohorts, 13 were studied with an observational design, 10 were studied prospectively, and four had parallel control groups. Mean age ranged form 41 to 64 yr, mean time on dialysis was 2 to 11 yr, 0 to 28% of patients had diabetes, >90% had arteriovenous fistulae, and >50% were dialyzed at home. Most data were described at <12 mo of follow-up. Outcomes included quality of life, cardiovascular disease, erythropoiesis, nutritional status, hospitalizations, and vascular access failures. Reporting was too heterogeneous to allow pooling of data. Ten of 11 studies suggested improvements in blood pressure; findings for other outcomes varied. Discontinuation of DHD occurred in 0 to 57% in-center and 0 to 15% home patients. Studies of DHD are limited by small sample size, nonideal control groups, selection and dropout biases, and paucity of data on potential risks. Randomized trials with adequate statistical power are required to establish the efficacy and the safety of DHD.

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“…One such study shows that LV hypertrophy may regress without a change in relative wall thickness, another measure of LV geometry (18). In several studies, including the FHN trial, lowering BP was strongly associated with regression of LV hypertrophy (9,10,(12)(13)(14). Prior studies of frequent dialysis that evaluated LV size in addition to mass did not specifically address LV geometry (10,13).…”

mentioning

confidence: 99%

“…Observational studies of frequent dialysis have shown salutary effects on BP (8)(9)(10)(11) and LV mass index (12)(13)(14)(15) and impressive survival rates (8,16). Moreover, LV hypertrophy has regressed in patients with ESRD who have baseline LV hypertrophy when aggressive management of BP and anemia was added to a thrice-weekly dialysis regimen (17,18).…”

mentioning

confidence: 99%

The Effects of Frequent Hemodialysis on Left Ventricular Mass, Volumes, and Geometry

Mishra

Dubin

2013

Clinical Journal of the American Society of Nephrology

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Left ventricular (LV) remodeling is defined as ''the genomic expression resulting in molecular, cellular, and interstitial changes that are manifested clinically as changes in size, shape, and function of the heart after cardiac injury" (1). In ESRD, LV remodeling manifests features of both concentric and eccentric LV hypertrophy, resulting from enlarged LV volumes and increased LV wall thickness (2). As we discuss here, LV mass can change because of a change in LV wall thickness, LV cavity size, or both. Increased LV mass, increased LV end-diastolic volume (LVEDV), and changes in LV geometry (LV mass/LVEDV) are all associated with poor prognosis in these patients (3,4). The Frequent Hemodialysis Network (FHN) trial is the first large-scale randomized controlled trial of frequent daily and nocturnal dialysis versus conventional dialysis (5). FHN investigators previously demonstrated that, compared with conventional hemodialysis, frequent daily hemodialysis results in a significantly greater reduction in LV mass, as determined by cardiac magnetic resonance imaging (MRI) (6). In this issue of CJASN, this group reports that frequent daily dialysis resulted in greater reductions in LV and right ventricular (RV) volumes without significant changes in LV geometry (7). In addition, reductions in both LV mass and LVEDV with frequent dialysis were significantly correlated with reductions in predialysis systolic BP (6,7). Here we present a brief overview of the literature on the effects of dialysis on LV remodeling, discuss likely mechanisms underlying the findings of the current study, and reflect on implications for future investigation.Observational studies of frequent dialysis have shown salutary effects on BP (8-11) and LV mass index (12-15) and impressive survival rates (8,16). Moreover, LV hypertrophy has regressed in patients with ESRD who have baseline LV hypertrophy when aggressive management of BP and anemia was added to a thrice-weekly dialysis regimen (17,18). One such study shows that LV hypertrophy may regress without a change in relative wall thickness, another measure of LV geometry (18). In several studies, including the FHN trial, lowering BP was strongly associated with regression of LV hypertrophy (9,10,(12)(13)(14). Prior studies of frequent dialysis that evaluated LV size in addition to mass did not specifically address LV geometry (10,13).LV mass and volume are linked mathematically, physiologically, and empirically. Cardiac MRI is widely considered to be the gold standard for determining LV volume and mass, while M-mode echocardiography overestimates LV mass in patients with ESRD undergoing hemodialysis because of its geometric assumptions (19). In cardiac MRI, LV mass is calculated as myocardial volume multiplied by the specific density of the myocardium (20). Myocardial volume, in turn, is the difference between the enddiastolic epicardial volume and end-diastolic endocardial volume, excluding the papillary muscles (LVEDV). Thus, while MRI-determined LV mass is free of geometric assumptions, it ...

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Anemia and Blood Pressure Correction Obtained by Daily Hemodialysis Induce a Reduction of Left Ventricular Hypertrophy in Dialysed Patients

Cited by 49 publications

References 2 publications

Effects of Short Daily versus Conventional Hemodialysis on Left Ventricular Hypertrophy and Inflammatory Markers

Effects of Short Daily versus Conventional Hemodialysis on Left Ventricular Hypertrophy and Inflammatory Markers

Daily Hemodialysis

The Effects of Frequent Hemodialysis on Left Ventricular Mass, Volumes, and Geometry

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