Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis

Chan, Christopher T.; Floras, John S.; Miller, Judith; Richardson, Robert; Pierratos, Andreas

doi:10.1046/j.1523-1755.2002.00362.x

Cited by 336 publications

(256 citation statements)

References 27 publications

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“…For example, Chan et al reported an improvement in both SBP and DBP, a reduction in antihypertensive drugs and doses, and a reduction in left ventricular mass in patients undergoing nocturnal dialysis. 115 This group also reported an improvement in pharyngeal size among nocturnally dialyzed patients. 117 This may improve sleep apnea and consequently ambulatory BP.…”

Section: Frequent Dialysis and Its Effect On Bpmentioning

confidence: 84%

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Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

157

156

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Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. Hypertension is common among patients with ESRD. In this review, we discuss the diagnosis, epidemiology, and management of hypertension among dialysis patients. We also review areas of existing controversies and briefly discuss the issue of hypertension in pediatric dialysis patients. EPIDEMIOLOGYThe prevalence, treatment, and control of hypertension among people on hemodialysis (HD) have used varying definitions to diagnose hypertension. The epidemiology differs based on how BP is measured: either before and after dialysis or using ambulatory BP recordings. Epidemiology with Routine BP MeasurementsThe prevalence of hypertension (defined as 1-week average predialysis systolic BP [SBP] measurements .150 mmHg or diastolic BP [DBP].85 mmHg or the use of antihypertensive medications) was 86% among 2535 clinically stable adult HD patients participating in a multicenter trial. 1 Among hypertensive patients, 12% did not receive antihypertensive drugs, 58% were treated but not controlled, and only 30% were controlled. The use of antihypertensive drugs has been reported to vary from 59% to 83%. [2][3][4][5] Furthermore, even among children on long-term HD, similar findings have been reported. 6 Several studies have confirmed greater antihypertensive drug use to be associated with poorer control. 7,8 It should be noted that antihypertensive drug use per se do not lead to worse BP control; in the absence of adequate volume control, increasing antihypertensive drug use may simply reflect difficult-to-control BP. Epidemiology Using Ambulatory BP MeasurementsThe prevalence of hypertension (defined by either a 44-hour interdialytic ambulatory BP of $135/85 mmHg or the prescription of any antihypertensive agent) was 86% among 369 chronic HD patients. 8 Although hypertension was being treated with antihypertensive drugs in 89% of patients, it was adequately controlled only in 38%. The independent determinants of poor control were the use of antihypertensive drugs and an expanded extracellular volume state. If patients were volume overloaded, nearly 80% became hypertensive when medications were Published online ahead of print. Publication date available at www.jasn.org.

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Section: Frequent Dialysis and Its Effect On Bpmentioning

confidence: 84%

“…115 In a cumulative analysis of 72 patients from nine centers it was noted that predialysis SBP and DBP fell within 1 month of dialysis by 13/7 mmHg from 163/94 mmHg. 116 This reduction was accompanied by a 1% decline in postdialysis weight.…”

Section: Frequent Dialysis and Its Effect On Bpmentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

157

156

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“…The study model is usually a before-and-after paradigm; frequently, a comparator group (an external control) that does not undergo the conversion to the alternative modality is added to enhance the internal validity of the study. Some relevant health parameter, such as LVM, phosphate binder use, hemoglobin concentration, or sleep pattern, is then studied while a patient is undergoing CHD and assessed again after some time interval while on NHD (19)(20)(21)(22). The presumption is that any change observed between measurements is due to the nocturnal dialysis.…”

Section: Quasi-experimental Studiesmentioning

confidence: 99%

Utility and Limitations of a Multicenter Nocturnal Home Hemodialysis Cohort

Copland

Komenda

Levin

et al. 2008

Clinical Journal of the American Society of Nephrology

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Nocturnal home hemodialysis (NHD) is the most intensive dialysis strategy among dialytic renal replacement options and is receiving increased attention as more research reveals its physiologic restorative potential compared with conventional hemodialysis; however, a significant gap in knowledge remains concerning the predictors of program success and the clinical outcomes of NHD. This review aims to highlight the methodologic strengths and pitfalls of various study designs as they pertain to NHD research and lays the foundation for the CANandian Slow Long nightly ExtEnded dialysis Programs (CAN-SLEEP), a multicenter NHD research network aimed to facilitate investigation of NHD.

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“…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%

“…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%

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

Mishra

Dubin

2013

Clinical Journal of the American Society of Nephrology

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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 ...

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Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis

Abstract: Reductions in BP with NHD are accompanied by regression of LVH.

Cited by 336 publications

References 27 publications

Assessment and Management of Hypertension in Patients on Dialysis

Assessment and Management of Hypertension in Patients on Dialysis

Utility and Limitations of a Multicenter Nocturnal Home Hemodialysis Cohort

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

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