Cardiovascular remodeling during long-term nocturnal home hemodialysis

Abstract

BackgroundCardiovascular disease is the leading cause of morbidity and mortality in patients with kidney failure. Nocturnal home hemodialysis (NHD) is a form of kidney replacement therapy whereby hemodialysis is performed for at least 6-h overnight, at least 4 days per week. Little is known about the effects of NHD on cardiovascular remodeling as assessed by transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR).ObjectivesThe primary objective of the study was to determine the long-term effects of NHD on cardiovascular remodeling using different imaging modalities over a one-year follow-up.Methods and resultsA total of 11 patients were included in the study (6 males, mean age 48 ± 16 years) between 2009 and 2011 inclusive at a single tertiary care center. All patients underwent TTE and CMR at baseline and after 1 year of NHD. Left ventricular mass index decreased significantly at 1 year by both TTE (152 ± 7–129 ± 8 g/m2, p < 0.05) and CMR (162 ± 4–124 ± 4 g/m2, p < 0.05). There was also a significant decrease in both left and right atrial volume as well as in right ventricular mass index over 1 year of follow-up. Diastolic dysfunction, graded from 0 to 4, improved from a baseline grade of 3.4 to 1.2 at 1-year follow-up.ConclusionsLong-term nocturnal hemodialysis leads to favorable cardiovascular remodeling with a reduction in cavity dimensions, regression of left ventricular hypertrophy, and an improvement in diastolic function, as assessed by both TTE and CMR.

Intensive Home Hemodialysis Results in Regression of Left Ventricular Hypertrophy and Better Clinical Outcomes

“…Moreover, our results show that LVH regression or prevention may be achieved in a substantial proportion of patients with intensive more frequent hemodialysis, regardless of renal replacement therapy modality prior to initiation. These results are also consistent with other studies demonstrating improved LVM with intensive hemodialysis [16,[20][21][22] . This is in contrast to studies in peritoneal dialysis or conventional hemodialysis, which have shown that LVH develops and progresses in the majority of patients with time [4,14] .…”

“…Sixteen patients (18.4%) in the regressor group and 19 patients Studies in conventional hemodialysis and peritoneal dialysis have shown that LVH progresses with time in most patients [4,14,15] . In contrast, there has been many studies in recent years demonstrating that frequent hemodialysis (short-daily or long-nocturnal) leads to LVH regression along with improvements in blood pressure control, abnormalities of mineral metabolism, sleep quality and quality of life [16][17][18][19][20][21] . In the Frequent Hemodialysis Network Daily Trial, 245 patients were randomized to 6X/week (short-daily or nocturnal) or 3X/week hemodialysis [22] .…”

<p>Nocturnal hemodialysis: improved quality of life and patient outcomes</p>

“…There was also a significant reduction in both left and right atrial volumes as well as in right ventricular (RV) mass index over 1 year of followup. 25 Diastolic dysfunction also improved from a baseline grade of 3.4 to 1.2 at 1 year of follow-up. In contrast, an analysis of the FHN Nocturnal Trial 26 revealed that there was no significant difference in LV or RV volume, or ejection fractions, with a good residual renal function for this cohort postulated to be one of the reasons contributing to this difference.…”

“…58 The live birth rate in the Canadian cohort (86.4%) was significantly higher than the American cohort (61.4%, P=0.03). The median duration of pregnancy in the more intensely dialyzed Toronto cohort was 36 weeks (interquartile range 32-37) compared to 27 weeks (interquartile range [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] in the American cohort.…”

Daily Home Hemodialysis Is an Available Option for Renal Replacement Therapy in Spain

“…Countries with long distances between the hospital and the patient's home, such as Canada, New Zealand, Australia, and the US, have well‐developed HHD programs . Although distance is not a problem in Spain—patients rarely live more than 10 km from a hospital—two patients moved to a larger city in order to be nearer to a hospital.…”