Intensive hemodialysis for cardiomyopathy associated with end-stage renal disease

Nehus, Edward; Goebel, Jens; Mitsnefes, Mark; Lorts, Angela; Laskin, Benjamin L.

doi:10.1007/s00467-011-1921-y

Cited by 8 publications

(5 citation statements)

References 17 publications

(17 reference statements)

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“…In agreement with recent daily dialysis studies, cardiac features as assessed by echocardiography were improved with intensive dialysis at home [ 23 , 24 , 25 , 26 ]. As shown in a subgroup of patients, left ventricular mass was reduced by 9.6% at 3 months, while the ejection fraction remained remarkably stable in the normal range of 61 to 62%.…”

Section: Discussionsupporting

confidence: 88%

Two Years’ Experience of Intensive Home Hemodialysis with the Physidia S3 System: Results from the RECAP Study

Fessi

Nicoud²,

Serrato³

et al. 2023

JCM

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The RECAP study reports results and outcomes (clinical performances, patient acceptance, cardiac outcomes, and technical survival) achieved with the S3 system used as an intensive home hemodialysis (HHD) platform over a three-year French multicenter study. Ninety-four dialysis patients issued from ten dialysis centers and treated more than 6 months (mean follow-up: 24 months) with S3 were included. A two-hour treatment time was maintained in 2/3 of patients to deliver 25 L of dialysis fluid, while 1/3 required up to 3 h to achieve 30 L. The additional convection volume produced by means of the SeCoHD tool (internal filtration backfiltration) was 3 L/session, and the net ultrafiltration produced to achieve dry weight was 1.4 L/session. On a weekly basis, an average 156 L of dialysate corresponding to 94 L of urea clearance when considering 85% dialysate saturation under low flow conditions was delivered. Such urea clearance was equivalent to 9.2 [8.0–13.0] mL/min weekly urea clearance and a standardized Kt/V of 2.5 [1.1–4.5]. The predialysis concentration of selected uremic markers remained remarkably stable over time. Fluid volume status and blood pressure were adequately controlled by means of a relatively low ultrafiltration rate (7.9 mL/h/kg). Technical survival on S3 was 72% and 58% at 1 and 2 years, respectively. The S3 system was easily handled and kept by patients at home, as indicated by technical survival. Patient perception was improved, while treatment burden was reduced. Cardiac features (assessed in a subset of patients) tended to improve over time. Intensive hemodialysis relying on the S3 system offers a very appealing option for home treatment with quite satisfactory results, as shown in the RECAP study throughout a two-year follow-up time, and offers the best bridging solution to kidney transplantation.

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Section: Discussionsupporting

confidence: 88%

Two Years’ Experience of Intensive Home Hemodialysis with the Physidia S3 System: Results from the RECAP Study

Fessi

Nicoud²,

Serrato³

et al. 2023

JCM

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“…CRS 4 (CKD leading to heart failure) seems to be the least studied with most of the data restricted to case report/series. Nehus et al[ 36 ] described a case report of an 11-year-old child with end-stage kidney disease (ESKD) who developed a DCM and decompensated heart failure postunilateral nephrectomy while on maintenance peritoneal dialysis (PD). His electrocardiogram showed diffuse chamber enlargement, severely depressed biventricular function, and LVEF of 10%.…”

Section: Resultsmentioning

confidence: 99%

“…[ 35 ] AKI is a common complication in cases of sepsis, occurring in as many as 51% of patients in septic shock. [ 36 ] Activation of coagulation and fibrinolytic systems leads to endothelial injury, affecting filtration function. [ 37 ] Sepsis also affects cardiac and/or renal function via the renin–angiotensin–aldosterone system (RAAS) and hypothalamus–pituitary–adrenal axis.…”

Section: Resultsmentioning

confidence: 99%

“…[ 61 ] The implementation of kidney replacement therapy (KRT) in CRS type 4 may improve outcomes. Nehus et al[ 36 ] described a pediatric patient with ESKD who developed a DCM, resulting in decompensated heart failure postunilateral nephrectomy. The patient showed significant improvement in cardiac function with intensive KRT suggesting the benefits of KRT in treating and preventing cardiovascular disease-related morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

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Cardiorenal syndrome in the pediatric population: A systematic review

Sinha¹,

Pradhan²,

Adnani³

et al. 2022

Ann Pediatr Card

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The concept of cardiorenal syndrome (CRS) is derived from the crosstalk between the heart and kidneys in pathological conditions. Despite the rising importance of CRS, there is a paucity of information on the understanding of its pathophysiology and management, increasing both morbidity and mortality for patients. This review summarizes the existing conceptual pathophysiology of different types of CRS and delves into the associated therapeutic modalities with a focus on pediatric cases. Prospective or retrospective observational studies, comparative studies, case reports, case–control, and cross-sectional studies that include pediatric patients with CRS were included in this review. Literature was searched using PubMed, EMBASE, and Google Scholar with keywords including “cardio-renal syndrome, type,” “reno-cardio syndrome,” “children,” “acute kidney injury,” and “acute decompensated heart failure” from January 2000 to January 2021. A total of 14 pediatric studies were ultimately included and analyzed, comprising a combined population of 3608 children of which 32% had CRS. Of the 14 studies, 57% were based on type 1 CRS, 14% on types 2 and 3 CRS, and 7% were on types 4 and 5 CRS. The majority of included studies were prospective cohort, although a wide spectrum was observed in terms of patient age, comorbidities, etiologies, and treatment strategies. Commonly observed comorbidities in CRS type 1 were hematologic, oncologic, cardiology-related side effects, muscular dystrophy, and pneumonia/bronchiolitis. CRS, particularly type 1, is prevalent in children and has a significant risk of mortality. The current treatment regimen primarily involves diuretics, extracorporeal fluid removal, and treatment of underlying etiologies and comorbidities.

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“…Chan et al showed that nocturnal hemodialysis, which is an emerging mode of intensive hemodialysis, improved uremic clearance, Hb levels and hematopoietic progenitor cell function significantly in patients with ESRD (20). In a similar study by Nehus et al, cardiac function improved after beginning intensive hemodialysis in pediatric patients with ESRD (25). At the beginning of the present study, Hb concentrations were higher than 11 g/dL in 12.26% of the patients, while 62.29% had normal Hb concentrations, which indicates the effectiveness of the intervention.…”

Section: Discussionmentioning

confidence: 97%

The effect of intensive hemodialysis on pulmonary arterial pressure and left ventricular systolic function in patients with end-stage renal disease; a prospective clinical trial

et al. 2020

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Introduction: End-stage renal disease (ESRD) requires hemodialysis or kidney transplantation for the patients to survive. Objectives: The present study was conducted to examine whether intensive hemodialysis and hemoglobin (Hb) concentration correction can improve left ventricular (LV) function and pulmonary arterial hypertension in ESRD patients? Patients and Methods: This prospective clinical trial was designed to examine patients referring to public hospitals in Ahvaz, Iran, in 2016-2017. All the patients treated with intensive hemodialysis for two months were included in the study. The Hb concentration was corrected by the subcutaneous injection of erythropoietin at the dose of 50-150 IU/kg three times per week. Results: Thirty-one ESRD patients with high pulmonary arterial pressure participated in this study. After the intervention, blood Hb levels increased significantly in the ESRD patients from 9.20±1.39 g/dL to 10.96±1.01 g/dL (P<0.0001). Pulmonary arterial pressure decreased significantly from 53.52±10.63 mmHg to 43.32±10.92 mm Hg (P<0.0001). Left ventricular ejection fraction increased significantly based on the visual assessment and Simpson’s method (2D echocardiography) from 41.06±10.76 to 43.00±11.28 and 46.26±13.72 to 48.36±13.90, respectively (P<0.0001). Absolute value of two dimensional global longitudinal strain (GLS) increased significantly from 13.99±5.05 to 15.14±5.32 (P<0.0001) after the intervention. Conclusion: Intensive hemodialysis for two months resulted in a significant increase in Hb concentrations, improved the LV systolic function and decreased pulmonary hypertension in ESRD patients. Trial registration: The trial protocol was approved in the Iranian Registry of Clinical Trials (identifier: IRCT20180212038705N1, https://www.irct.ir/trial/29593; Ethic code: IR.AJUMS. REC.1396.911).

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Intensive hemodialysis for cardiomyopathy associated with end-stage renal disease

Cited by 8 publications

References 17 publications

Two Years’ Experience of Intensive Home Hemodialysis with the Physidia S3 System: Results from the RECAP Study

Two Years’ Experience of Intensive Home Hemodialysis with the Physidia S3 System: Results from the RECAP Study

Cardiorenal syndrome in the pediatric population: A systematic review

The effect of intensive hemodialysis on pulmonary arterial pressure and left ventricular systolic function in patients with end-stage renal disease; a prospective clinical trial

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