Effects of thrice-weekly in-center nocturnal vs. conventional hemodialysis on integrated backscatter of myocardial tissue

Abstract

Ultrasonic tissue characterization with integrated backscatter (IBS) offers a promising method for the noninvasive assessment of myocardial fibrosis and contractile performance. The aim of this study was to investigate the effect of thrice-weekly in-center nocturnal hemodialysis (INHD) and conventional hemodialysis (CHD) on myocardial fibrosis and left ventricular function in end-stage renal disease patients. Thirty-two INHD and 58 matched CHD patients were enrolled; baseline and 12-month measures of blood pressure (BP), serum calcium and phosphorus, echocardiographic left ventricular mass index (LVMI) and left ventricular function, the myocardial calibrated IBS (C-IBS), and systodiastolic cyclical variations in IBS (CV-IBS) were collected. The baseline characteristics were similar between groups, except that serum phosphorus and calcium × phosphorus were higher in the INHD group. At 12-month follow-up, there was a significant decrease in the mean C-IBS (-20.2 ± 3.7 to -28.1 ± 4.0 dB, P<0.01) and a significant increase in CV-IBS (5.0 ± 1.5 to 7.1 ± 1.6 dB, P<0.01) in INHD patients. Multivariate analysis showed that the mean C-IBS was positively related to SBP, DBP, LVMI, serum phosphorus, and left atrial volume index and inversely related to midwall fractional shortening, transmitral E/A ratio, and E(m) . The mean CV-IBS was positively correlated with left ventricular midwall fractional shortening, E/A ratio, E(m) and inversely correlated with SBP, DBP, LVMI, serum phosphorus, E/E(m) , and left atrial volume index. There was no significant change in the mean C-IBS, mean CV-IBS, and LVMI in the CHD group. Compared with CHD, INHD improves myocardial fibrosis and left ventricular function, and control of serum phosphorus is associated with the improvement of myocardial fibrosis. Improvement of myocardial fibrosis contributes to the reduction of left ventricle hypertrophy.

The Association Between Conversion to In-centre Nocturnal Hemodialysis and Left Ventricular Mass Regression in Patients With End-Stage Renal Disease

“…As observed by others, [24][25][26] we showed a significant reduction in the number of prescribed antihypertensive medications such that patients who converted to INHD received on average 0.5-1 fewer agents, presumably due to improved blood pressure control. A nonsignificant trend toward blood pressure lowering was also evident among the INHD recipients, a finding that became statistically significant in the per-protocol analyses.…”

“…28 This suggests that the LVM regression associated with INHD conversion is not directly mediated by enhanced FGF-23 removal or suppression of its production. Conversion to INHD was associated with a reduction in serum phosphate concentration, as observed in other INHD cohorts 24,26,29 and with other forms of intensified dialysis. 30,31 This is compatible with the extensive literature documenting the importance of dialysis time prolongation on phosphate removal, 32 in light of data linking hyperphosphatemia with vascular calcification 33 and the epidemiologic association between serum phosphate concentration and mortality.…”

Imaging of Myocardial Fibrosis in Patients with End-Stage Renal Disease: Current Limitations and Future Possibilities

“…Studies that have used IB in HD patients are summarised in Table 2 [60–62]. Salvetti et al found that mean reflectivity of IB was increased progressively from 48% in patients with essential hypertension to 56% in patients with CKD, further increasing to 62% in HD patients ( p < 0.01 for all groups) [60].…”

“…Furthermore, they performed intraobserver variability of IB measurement in 10 consecutive patients, finding variability to be 2%, with a repeatability coefficient of 1.35. A nonrandomised study by Jin et al assessed the effect of incentre nocturnal HD (INHD) on cIB measurements [62]. They showed that cIB reduced in patients on INHD compared to conventional HD.…”

Cardiac Remodelling in Patients Undergoing in-Centre Nocturnal Haemodialysis: Results from the MIDNIGHT Study, a Non-Randomized Controlled Trial

“…While home-based HD provides extended or more frequent HD for some patients, there are barriers (patient-related and physician-related) to many undertaking home-HD programs; in-centre nocturnal haemodialysis (INHD) is an underutilized method of delivering extended HD. Evidence suggests INHD programs are feasible [16], may improve a number of clinical endpoints [15,17,18,19,20,21], reduce LV mass [22] and even improve survival [23]. …”