Left Ventricular Hypertrophy in Daily Dialysis

Abstract

Cardiac hypertrophy, a well-known independent risk factor for cardiovascular death, is a very frequent complication in ESRD patients. Its frequency tends to be even higher in dialyzed patients due to the fact that the current dialytic treatments are unable to keep under a satisfactory control the various responsible factors and particularly the blood pressure, which is largely the most important. Daily hemodialysis, a more frequent schedule consisting of 6–7 sessions/week lasting 2 or more hours, has definitely proved its superiority in controlling blood pressure and in improving anemia, and thus has the requisites for positively influencing cardiac hypertrophy. In fact, a series of studies, both retrospective and prospective, performed during the last years by our group, have confirmed that this new, more frequent and thus more physiological schedule, is able not only to stop the progression of the cardiac hypertrophy in uremic patients but also to revert toward the normality, in a relatively short time. This appears to be essentially a consequence of the excellent blood pressure control, which in turn derives from the easier control of the true dry weight, achievable with this type of dialytic treatment.

Atrial fibrillation in chronic dialysis patients in the United states: risk factors for hospitalization and mortality

“…[31] Also, hospitalized congestive heart failure is more common in hemodialysis than peritoneal dialysis patients, especially for those on the renal transplant waiting list. [32] The typical regimen for hemodialysis is likely far less physiologic than peritoneal dialysis. Residual renal function may also be preserved longer in patients on peritoneal dialysis, although this is controversial.…”

Atrial fibrillation in haemodialysis patients: Do the guidelines for anticoagulation apply?

“…[1][2][3][4] AF appears more frequent in haemodialysis patients, and may be related to factors such as progressive cardiac enlargement, left ventricular hypertrophy and the nonphysiological nature of haemodialysis. 5,6 In end-stage renal disease, there is an increased risk of haemorrhage due to vessel wall and platelet abnormalities in addition to factors that inhibit normal platelet adhesion and aggregation mechanisms. [7][8][9] The risk of bleeding is especially high in haemodialysis patients, because of the use of anticoagulants during dialysis.…”

JapaneseSociety forDialysisTherapyClinicalGuideline for “Maintenance Hemodialysis: Hemodialysis Prescriptions”

“…The effects of short frequent treatments with HD were compared with those of conventional HD among patients treated at dialysis centers. The findings obtained were clear, because the survey comprised a large patient population and was conducted with patients treated at centers . The LVMI and physical health composite scores were the primary outcome measures, and they were significantly better among patients undergoing short frequent HD treatments.…”

“…Left ventricular hypertrophy tends to be found among dialysis patients and is a factor influencing their poor prognoses. Frequent HD reportedly decreases the incidence of left ventricular hypertrophy . An FHN RCT recently carried out in North America compared in‐center HD six times per week for 1.5–2.75 h, total dialysis time of 12.7 ± 2.2 h per week, with HD three times per week for 2.5–4.0 h, total dialysis time of 10.4 ± 1.6 h per week, and it found that frequent HD significantly decreases the left ventricular mass index (LVMI) , which may relate to BW and blood pressure being well controlled by frequent HD.…”