Effects of an increase in time vs. frequency on cardiovascular parameters in chronic hemodialysis patients

Weinreich, T; Ríos, Tatiana De los; Gauly, Adelheid; Passlick–Deetjen, Jutta

doi:10.5414/cnp66433

Cited by 33 publications

(21 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This has led to questions regarding the appropriateness of continuing use of a dialysis prescription that has been in effect since the early 1960s. More frequent hemodialysis (including short-daily or long-nocturnal dialysis) has been suggested as a new paradigm of treatment (92)(93)(94). Observational (cross-sectional) studies have shown a somewhat lower prevalence of LVH in CAPD compared with conventional hemodialysis therapy (52), but these studies are subject to potential confounding, effects of residual renal function, and the differences in arteriovenous fistula utilization.…”

Section: What Are the Key Principles Of Management Of Lvh In Ckd And mentioning

confidence: 99%

“…Observational (cross-sectional) studies have shown a somewhat lower prevalence of LVH in CAPD compared with conventional hemodialysis therapy (52), but these studies are subject to potential confounding, effects of residual renal function, and the differences in arteriovenous fistula utilization. In addition, observational studies have shown that more frequent or longer hemodialysis sessions are associated strongly with a much lower prevalence of LVH (92)(93)(94). In a small short-term randomized trial, Culleton et al (68) showed striking reductions in LVH (and systolic BP as well) despite only minor changes in serum phosphorous and no changes in hemoglobin levels when frequent nocturnal dialysis was compared with conventional hemodialysis.…”

Section: What Are the Key Principles Of Management Of Lvh In Ckd And mentioning

confidence: 99%

See 1 more Smart Citation

Left Ventricular Mass in Chronic Kidney Disease and ESRD

Glassock

Pecoits‐Filho

Barberato

2009

Clinical Journal of the American Society of Nephrology

322

279

View full text Add to dashboard Cite

Chronic kidney disease (CKD) and ESRD, treated with conventional hemo-or peritoneal dialysis are both associated with a high prevalence of an increase in left ventricular mass (left ventricular hypertrophy [LVH]), intermyocardial cell fibrosis, and capillary loss. Cardiac magnetic resonance imaging is the best way to detect and quantify these abnormalities, but M-Mode and 2-D echocardiography can also be used if one recognizes their pitfalls. The mechanisms underlying these abnormalities in CKD and ESRD are diverse but involve afterload (arterial pressure and compliance), preload (intravascular volume and anemia), and a wide variety of afterload/preload independent factors. The hemodynamic, metabolic, cellular, and molecular mediators of myocardial hypertrophy, fibrosis, apoptosis, and capillary degeneration are increasingly well understood. These abnormalities predispose to sudden cardiac death, most likely by promotion of electrical instability and re-entry arrhythmias and congestive heart failure. Current treatment modalities for CKD and ESRD, including thrice weekly conventional hemodialysis and peritoneal dialysis and metabolic and anemia management regimens, do not adequately prevent or correct these abnormalities. A new paradigm of therapy for CKD and ESRD that places prevention and reversal of LVH and cardiac fibrosis as a high priority is needed. This will require novel approaches to management and controlled interventional trials to provide evidence to fuel the transition from old to new treatment strategies. In the meantime, key management principles designed to ameliorate LVH and its complications should become a routine part of the care of the patients with CKD and ESRD.

show abstract

Section: What Are the Key Principles Of Management Of Lvh In Ckd And mentioning

confidence: 99%

Section: What Are the Key Principles Of Management Of Lvh In Ckd And mentioning

confidence: 99%

Left Ventricular Mass in Chronic Kidney Disease and ESRD

Glassock

Pecoits‐Filho

Barberato

2009

Clinical Journal of the American Society of Nephrology

322

279

View full text Add to dashboard Cite

show abstract

“…1,2 Lengthening dialysis session times to .5.5 hours provides substantially greater solute clearance and extracellular fluid volume control, potentially leading to improved outcomes. [3][4][5] Unfortunately, there are no randomized trials evaluating the effects of extended hours hemodialysis regimens on survival. Previous observational studies have suggested that lengthening hemodialysis session time to .6 hours, and increasing frequency to $5 treatments per week may be associated with improved survival.…”

mentioning

confidence: 99%

Intensive Hemodialysis Associates with Improved Survival Compared with Conventional Hemodialysis

Nesrallah

Lindsay

Cuerden

et al. 2012

Journal of the American Society of Nephrology

189

170

View full text Add to dashboard Cite

Patients undergoing conventional maintenance hemodialysis typically receive three sessions per week, each lasting 2.5-5.5 hours. Recently, the use of more intensive hemodialysis (.5.5 hours, three to seven times per week) has increased, but the effects of these regimens on survival are uncertain. We conducted a retrospective cohort study to examine whether intensive hemodialysis associates with better survival than conventional hemodialysis. We identified 420 patients in the International Quotidian Dialysis Registry who received intensive home hemodialysis in France, the United States, and Canada between January 2000 and August 2010. We matched 338 of these patients to 1388 patients in the Dialysis Outcomes and Practice Patterns Study who received in-center conventional hemodialysis during the same time period by country, ESRD duration, and propensity score. The intensive hemodialysis group received a mean (SD) 4.8 (1.1) sessions per week with a mean treatment time of 7.4 (0.87) hours per session; the conventional group received three sessions per week with a mean treatment time of 3.9 (0.32) hours per session. During 3008 patient-years of follow-up, 45 (13%) of 338 patients receiving intensive hemodialysis died compared with 293 (21%) of 1388 patients receiving conventional hemodialysis (6.1 versus 10.5 deaths per 100 personyears; hazard ratio, 0.55 [95% confidence interval, 0.34-0.87]). The strength and direction of the observed association between intensive hemodialysis and improved survival were consistent across all prespecified subgroups and sensitivity analyses. In conclusion, there is a strong association between intensive home hemodialysis and improved survival, but whether this relationship is causal remains unknown.

show abstract

“…One such study shows that LV hypertrophy may regress without a change in relative wall thickness, another measure of LV geometry (18). In several studies, including the FHN trial, lowering BP was strongly associated with regression of LV hypertrophy (9,10,(12)(13)(14). Prior studies of frequent dialysis that evaluated LV size in addition to mass did not specifically address LV geometry (10,13).…”

mentioning

confidence: 99%

“…Observational studies of frequent dialysis have shown salutary effects on BP (8)(9)(10)(11) and LV mass index (12)(13)(14)(15) and impressive survival rates (8,16). Moreover, LV hypertrophy has regressed in patients with ESRD who have baseline LV hypertrophy when aggressive management of BP and anemia was added to a thrice-weekly dialysis regimen (17,18).…”

mentioning

confidence: 99%

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

Mishra

Dubin

2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Left ventricular (LV) remodeling is defined as ''the genomic expression resulting in molecular, cellular, and interstitial changes that are manifested clinically as changes in size, shape, and function of the heart after cardiac injury" (1). In ESRD, LV remodeling manifests features of both concentric and eccentric LV hypertrophy, resulting from enlarged LV volumes and increased LV wall thickness (2). As we discuss here, LV mass can change because of a change in LV wall thickness, LV cavity size, or both. Increased LV mass, increased LV end-diastolic volume (LVEDV), and changes in LV geometry (LV mass/LVEDV) are all associated with poor prognosis in these patients (3,4). The Frequent Hemodialysis Network (FHN) trial is the first large-scale randomized controlled trial of frequent daily and nocturnal dialysis versus conventional dialysis (5). 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). 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.Observational studies of frequent dialysis have shown salutary effects on BP (8-11) and LV mass index (12-15) and impressive survival rates (8,16). Moreover, LV hypertrophy has regressed in patients with ESRD who have baseline LV hypertrophy when aggressive management of BP and anemia was added to a thrice-weekly dialysis regimen (17,18). One such study shows that LV hypertrophy may regress without a change in relative wall thickness, another measure of LV geometry (18). In several studies, including the FHN trial, lowering BP was strongly associated with regression of LV hypertrophy (9,10,(12)(13)(14). Prior studies of frequent dialysis that evaluated LV size in addition to mass did not specifically address LV geometry (10,13).LV mass and volume are linked mathematically, physiologically, and empirically. Cardiac MRI is widely considered to be the gold standard for determining LV volume and mass, while M-mode echocardiography overestimates LV mass in patients with ESRD undergoing hemodialysis because of its geometric assumptions (19). In cardiac MRI, LV mass is calculated as myocardial volume multiplied by the specific density of the myocardium (20). Myocardial volume, in turn, is the difference between the enddiastolic epicardial volume and end-diastolic endocardial volume, excluding the papillary muscles (LVEDV). Thus, while MRI-determined LV mass is free of geometric assumptions, it ...

show abstract

Effects of an increase in time vs. frequency on cardiovascular parameters in chronic hemodialysis patients

Cited by 33 publications

References 0 publications

Left Ventricular Mass in Chronic Kidney Disease and ESRD

Left Ventricular Mass in Chronic Kidney Disease and ESRD

Intensive Hemodialysis Associates with Improved Survival Compared with Conventional Hemodialysis

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

Contact Info

Product

Resources

About