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Titolo Effects of Frequent Hemodialysis on Ventricular Volumes and Left Ventricular Remodeling
Autore Christopher T. Chan, Tom Greene, Glenn M. Chertow, Alan S. Kliger, John B. Stokes, Gerald J. Beck,John T. Daugirdas, Peter Kotanko, Brett Larive, Nathan W. Levin, Ravindra L. Mehta, Michael Rocco, Javier Sanz, Phillip C. Yang, Sanjay Rajagopalan and the Frequent Hemodialysis Network Trial Group
Referenza Clin J Am Soc Nephrol 2013; 8: 2106–2116, doi: 10.2215/CJN.03280313
Contenuto

Background and objectives Higher left ventricular volume is associated with death in patients with ESRD. This work investigated the effects of frequent hemodialysis on ventricular volumes and left ventricular remodeling.

Design, setting, participants, & measurements The Frequent Hemodialysis Network daily trial randomized 245 patients to 12 months of six times per week versus three times per week in-center hemodialysis; the Frequent Hemodialysis Network nocturnal trial randomized 87 patients to 12 months of six times per week nocturnal hemodialysis versus three times per week predominantly home-based hemodialysis. Left and right ventricular end systolic and diastolic volumes, left ventricular mass, and ejection fraction at baseline and end of the study were ascertained by cardiac magnetic resonance imaging. The ratio of left ventricular mass/left ventricular end diastolic volumewas used as a surrogate marker of left ventricular remodeling. In each trial, the effect of frequent dialysis on left or right ventricular end diastolic volume was tested between predefined subgroups.

Results In the daily trial, frequent hemodialysis resulted in significant reductions in left ventricular end diastolic volume (211.0% [95% confidence interval, 216.1% to 25.5%]), left ventricular end systolic volume (214.8% [222.7% to 26.2%]), right ventricular end diastolic volume (211.6% [219.0% to 23.6%]), and a trend for right ventricular end systolic volume(211.3%[221.4%to 0.1%]) compared with conventional therapy. Themagnitude of reduction in left and right ventricular end diastolic volumes with frequent hemodialysis was accentuated among patients with residual urine output,100 ml/d (P value [interaction]=0.02). In the nocturnal trial, there were no significant changes in left or right ventricular volumes. The frequent dialysis interventions had no substantial effect on the ratio of left ventricular mass/left ventricular end diastolic volume in either trial.

Conclusions Frequent in-center hemodialysis reduces left and right ventricular end systolic and diastolic ventricular volumes as well as left ventricular mass, but it does not affect left ventricular remodeling.

Data 20.01.2014
 
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