Effects of Frequent Hemodialysis on Ventricular Volumes and Left Ventricular Remodeling

Abstract

SummaryBackground and objectives Higher left ventricular volume is associated with death in patients with ESRD. This work investigated the effects of frequent hemodialysis on ventricular volumes and left ventricular remodeling.Design, setting, participants, & measurements The Frequent Hemodialysis Network daily trial randomized 245 patients to 12 months of six times per week versus three times per week in-center hemodialysis; the Frequent Hemodialysis Network nocturnal trial randomized 87 patients to 12 months of six times per week nocturnal hemodialysis versus three times per week predominantly home-based hemodialysis. Left and right ventricular end systolic and diastolic volumes, left ventricular mass, and ejection fraction at baseline and end of the study were ascertained by cardiac magnetic resonance imaging. The ratio of left ventricular mass/left ventricular end diastolic volume was used as a surrogate marker of left ventricular remodeling. In each trial, the effect of frequent dialysis on left or right ventricular end diastolic volume was tested between predefined subgroups.

Randomized Controlled Trial of Individualized Dialysate Cooling for Cardiac Protection in Hemodialysis Patients

“…Conventional approaches to achieve this have largely relied on the control of pressure and volume overload. Daily dialysis is an effective approach in this respect, and the Frequent Hemodialysis Network trials reported that HD six times weekly led to an adjusted mean reduction in LV mass (213.8 g; 95% CI, 221.8 to 25.8g) and LV enddiastolic volume (211.0%; 95% CI, 216% to 26%), with no change in EF over 12 months compared with conventional thrice-weekly HD (34,35). This trial reports a similar reduction in LV mass (215.6 g; 95% CI, 229.4 to 21.9 g) and LV end-diastolic volume (223.8 ml; 95% CI, 244.7 to 22.9 ml), with no change in EF over 12 months.…”

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

“…The strong correlation between LV mass and LVEDV in ESRD reflects the fact that LV hypertrophy is an adaptive response, at least in part, to chronic volume overload. In this issue of CJASN, this relationship between LV mass and LVEDV was reflected in the finding that most participants receiving frequent dialysis had reductions in both LV mass and LVEDV ( Figure 4 in Chan and colleagues' article) (7).…”

“…With frequent dialysis, there was a proportional decrease in both stroke volume (change, 210.58%) and LVEDV (change, 211.19%) ( Table 2 in Chan and colleagues' article) (7). Although this means that LV ejection fraction (stroke volume/LVEDV) did not change, we may infer that stroke work (stroke volume3LV Table 2 in Chan and colleagues' article).…”

“…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).…”

“…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.…”