Effect of Frequent Nocturnal Hemodialysis vs Conventional Hemodialysis on Left Ventricular Mass and Quality of Life

Abstract

Context Morbidity and mortality rates in hemodialysis patients remain excessive. Alterations in the delivery of dialysis may lead to improved patient outcomes. Objective To compare the effects of frequent nocturnal hemodialysis vs conventional hemodialysis on change in left ventricular mass and health-related quality of life over 6 months. Design, Setting, and Participants A 2-group, parallel, randomized controlled trial conducted at 2 Canadian university centers between August 2004 and December 2006. A total of 52 patients undergoing hemodialysis were recruited. Intervention Participants were randomly assigned in a 1:1 ratio to receive nocturnal hemodialysis 6 times weekly or conventional hemodialysis 3 times weekly. Main Outcome Measures The primary outcome was change in left ventricular mass, as measured by cardiovascular magnetic resonance imaging. The secondary outcomes were patient-reported quality of life, blood pressure, mineral metabolism, and use of medications. Results Frequent nocturnal hemodialysis significantly improved the primary outcome (mean left ventricular mass difference between groups, 15.3 g, 95% confidence interval [CI], 1.0 to 29.6 g; P=.04). Frequent nocturnal hemodialysis did not significantly improve quality of life (difference of change in EuroQol 5-D index from baseline, 0.05; 95% CI, −0.07 to 0.17; P=.43). However, frequent nocturnal hemodialysis was associated with clinically and statistically significant improvements in selected kidney-specific domains of quality of life (P=.01 for effects of kidney disease and P=.02 for burden of kidney disease). Frequent nocturnal hemodialysis was also associated with improvements in systolic blood pressure (P=.01 after adjustment) and mineral metabolism, including a reduction in or discontinuation of antihypertensive medications (16/26 patients in the nocturnal hemodialysis group vs 3/25 patients in the conventional hemodialysis group; PϽ.001) and oral phosphate binders (19/26 patients in the nocturnal hemodialysis group vs 3/25 patients in the conventional dialysis group; PϽ.001). No benefit in anemia management was seen with nocturnal hemodialysis. Conclusion This preliminary study revealed that, compared with conventional hemodialysis (3 times weekly), frequent nocturnal hemodialysis improved left ventricular mass, reduced the need for blood pressure medications, improved some measures of mineral metabolism, and improved selected measures of quality of life.

Nocturnal intermittent hemodialysis

“…However, the intensified HD programs have been found to improve phosphate homeostasis, blood pressure control and anemia control. The same advantages have been shown in SDHD and NHHD [23,24,32].…”

“…In this study, only 25 % of the patients with NHHD had more than five dialysis sessions per week [24]. In the other study on NHHD there was an improvement in a number of kidney-specific topics in the quality of life scores, while the whole quality of life remained unchanged [32]. In none of the studies on quality of life published to date were patients on intensified dialysis in worse condition than those on conventional dialysis.…”

Avaliação e manejo da doença cardiovascular em pacientes com doença renal crônica

“…Finally, more frequent HD sessions (short daily sessions) or prolonged nocturnal sessions have been compared with traditional sessions three times a week and with peritoneal dialysis, and important outcomes, such as better pressure control, reduction in LVH, and mortality, have been assessed. 54 Long-term actual cardiovascular benefit for those more frequent or prolonged therapies is being evaluated in an ongoing multicenter randomized study, predicted to end in 2010. 55 …”

Modalidades de hemodiálise ambulatorial: breve revisão

“…Hemodiálise noturna: Culleton et al (7) avaliaram os efeitos da hemodiálise noturna freqüente comparada com a hemodiálise convencional sobre o músculo cardíaco através de ressonância magnética, pressão sangüínea, metabolismo mineral, qualidade de vida e uso de medicamentos. Os resultados demonstraram grandes benefícios dessa terapia em relação à tradicional, pois se verificou melhora na pressão arterial, sendo reduzida a quantidade de medicação anti-hipertensiva com conseqüente melhora da qualidade de vida.…”