The Effect of Increased Frequency of Hemodialysis on Volume-Related Outcomes: A Secondary Analysis of the Frequent Hemodialysis Network Trials

Raimann, Jochen G.; Chan, Christopher T.; Daugirdas, John T.; Depner, Tom; Gotch, Frank A.; Greene, Tom; Kaysen, George A.; Kliger, Alan S.; Kotanko, Peter; Larive, Brett; Lindsay, Robert M.; Rocco, Michael V.; Chertow, Glenn M.; Levin, Nathan W.

doi:10.1159/000441966

Cited by 38 publications

(48 citation statements)

References 36 publications

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“…Hypothetically, PH in ESKD may be caused by increased right‐sided volume, elevated vascular resistance or both. Multiple studies have shown the effect of more frequent hemodialysis on the amelioration of overall time averaged volume control . In addition, our group has also demonstrated improved brachial artery responsiveness, reduction in systemic vascular resistance, and restored abnormal vascular smooth muscle cell biology by nocturnal home hemodialysis .…”

Section: Discussionmentioning

confidence: 55%

Correction of pulmonary hypertension with intensive hemodialysis: A case report

Girsberger

Thenganatt

Chan

2019

Hemodialysis International

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Pulmonary hypertension (PH) defined as a mean pulmonary arterial pressure ≥25 mmHg is a common complication in hemodialysis occurring in up to 58% of patients. PH is classified according to its etiology. We report in a patient with severe PH of mixed etiology (connective tissue disease and left‐sided heart failure) who improved after initiation of intensive home hemodialysis. We postulated that the use of a frequent mode of hemodialysis may ameliorate PH via enhanced volume control. Thereby, an intensive hemodialysis schedule may be preferred renal replacement modality in this patient population.

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Section: Discussionmentioning

confidence: 55%

Correction of pulmonary hypertension with intensive hemodialysis: A case report

Girsberger

Thenganatt

Chan

2019

Hemodialysis International

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“…It is more likely that changes in left ventricular mass are the result of changes in extracellular fluid volume status rather than changes in β2‐M or other uremic toxin concentrations especially over a relatively short period of time. Another secondary analysis of the FHN trials supports this contention . Furthermore, amyloid deposition in the joints of dialyzed patients takes several years to develop .…”

Section: Discussionmentioning

confidence: 98%

The effect of increased frequency of hemodialysis on serum cystatin C and β2‐microglobulin concentrations: A secondary analysis of the frequent hemodialysis network (FHN) trial

Huang

Kaysen

Levin

et al. 2019

Hemodialysis International

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Introduction: Small molecular weight toxin clearance is the main method of assessment of hemodialysis efficiency. Middle molecules including cystatin C (CysC) and Beta‐2 microglobulin (β2‐M) are understudied. We hypothesized that lowering of predialysis CysC and β2‐M serum concentrations would be affected by switching to more frequent hemodialysis. Methods: Predialysis CysC and β2‐M serum concentrations were measured from serum samples of the Frequent Hemodialysis Network (FHN) Daily and Nocturnal Trials. The differences between predialysis concentrations at baseline (while on conventional thrice weekly dialysis) and those after 12‐months of study (on more frequent dialysis) were compared separately by trial (Nocturnal, Daily). We tested the associations between predialysis serum CysC and β2‐M concentrations and outcomes. Findings: Forty‐nine percent and 52% of the patients from the FHN Daily and Nocturnal Trials respectively were included in this ancillary study. Predialysis serum CysC concentrations remained unchanged after intensifying hemodialysis dose by either modality. There was significant lowering of the serum β2‐M concentrations in the frequent Daily Trial hemodialysis group at 12 months in all patients and in patients without residual renal function at baseline (−3.8 ± 12.62 μg/mL, P = 0.004; −5.9 ± 12.99 μg/mL, P = 0.02, respectively). There were no significant differences between the baseline and the 12‐months predialysis β2‐M serum concentrations in the two control groups (Daily 3× and Nocturnal 3× groups). No association between the changes in the two biomarkers between baseline and 12‐months and in changes in left ventricular mass, physical‐health composite scores, hospitalization rate, and death were found. The numbers of hospitalizations and deaths were small. Discussion: β2‐M may be a better biomarker of dialysis dose than CysC. Reduction in the concentration of potentially toxic long‐lived proteins of the size of β‐2M is one potential long‐term benefit of more intensive dialysis that may be explored.

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“…Remarkably, a post hoc analysis carried out by the Frequent Hemodialysis Network trial showed that the improvement in left ventricular mass observed in cases of more frequent dialysis was likely caused by extracellular volume reduction directly and not only via an effect on blood pressure [67]. …”

Section: Management Of Fluid Overloadmentioning

confidence: 99%

Assessment and management of fluid overload in children on dialysis

Hayes

Paglialonga

2018

Pediatr Nephrol

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Dysregulation of intravascular fluid leads to chronic volume overload in children with end-stage kidney disease (ESKD). Sequelae include left ventricular hypertrophy and remodeling and impaired cardiac function. As a result, cardiovascular complications are the commonest cause of mortality in the pediatric dialysis population. The clinical need to optimize intravascular volume in children with ESKD is clear; however, its assessment and management is the most challenging aspect of the pediatric dialysis prescription. Minimizing chronic fluid overload is a key priority; however, excessive ultrafiltration is toxic to the myocardium and can precipitate intradialytic symptoms. This review outlines emerging objective techniques to enhance the assessment of fluid overload in children on dialysis and outlines evidence for current management strategies to address this clinical problem.

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The Effect of Increased Frequency of Hemodialysis on Volume-Related Outcomes: A Secondary Analysis of the Frequent Hemodialysis Network Trials

Cited by 38 publications

References 36 publications

Correction of pulmonary hypertension with intensive hemodialysis: A case report

Correction of pulmonary hypertension with intensive hemodialysis: A case report

The effect of increased frequency of hemodialysis on serum cystatin C and β2‐microglobulin concentrations: A secondary analysis of the frequent hemodialysis network (FHN) trial

Assessment and management of fluid overload in children on dialysis

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