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The evidence is clear: intensive hemodialysis reduces left ventricular hypertrophy and may reduce risk of cardiovascular complications

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Cardiovascular death is significantly more likely in dialysis patients than in age-matched, community-dwelling adults in the US, despite dramatic increase in the use of cardioprotective medications.1 New strategies are clearly needed to improve cardiovascular health in dialysis patients. Because left ventricular hypertrophy (LVH) is an important predictor of cardiovascular mortality and morbidity, strategies to reduce LVH are likely to reduce cardiovascular disease risk in patients.2

INTENSIVE DIALYSIS REDUCES LVH

Multiple randomized clinical trials show that intensive hemodialysis reduces left ventricular mass:

  • In the Frequent Hemodialysis Network trials, short daily and nocturnal schedules, each for six sessions per week, reduced left ventricular mass by 10% and 8%, respectively, relative to three sessions per week.3,4
  • Comparable efficacy was observed in an earlier Canadian trial of nocturnal hemodialysis.5

LVH RELATED TO CARDIOVASCULAR RISK

Clinical benefits have been reported in observational studies:

  • Daily home hemodialysis was associated with 17% and 16% lower risks of cardiovascular death and hospitalization, as compared to conventional hemodialysis.6
  • Relative to peritoneal dialysis, daily home hemodialysis was likewise associated with lower risk of cardiovascular hospitalization.7

CONCLUSION

More intensive hemodialysis is a strategy to improve cardiovascular health for dialysis patients. Multiple controlled trials have consistently shown significant reductions in LVH with intensive hemodialysis. LVH reduction has been associated with improved cardiovascular outcomes and survival.

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All forms of hemodialysis, including treatments performed in-center and at home, involve some risks. In addition, there are certain risks unique to treatment in the home environment. Patients differ and not everyone will experience the reported benefits of more frequent hemodialysis.

Certain risks associated with hemodialysis treatment are increased when performing solo home hemodialysis because no one is present to help the patient respond to health emergencies.

Certain risks associated with hemodialysis treatment are increased when performing nocturnal therapy due to the length of treatment time and because therapy is performed while the patient and care partner are sleeping.

References

  1. Saran R, Li Y, Robinson B, et al. US Renal Data System 2014 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2015;66(1 Suppl 1):Svii, S1-305. doi:10.1053/j.ajkd.2015.05.001.
  2. Mathew J, Sleight P, Lonn E, et al. Reduction of cardiovascular risk by regression of electrocardiographic markers of left ventricular hypertrophy by the angiotensin-converting enzyme inhibitor ramipril. Circulation. 2001;104(14):1615-1621.
  3. FHN Trial Group, Chertow GM, Levin NW, et al. In-center hemodialysis six times per week versus three times per week. N Engl J Med. 2010;363(24):2287-2300. doi:10.1056/NEJMoa1001593.
  4. Rocco MV, Lockridge RS, Beck GJ, et al. The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial. Kidney Int. 2011;80(10):1080-1091. doi:10.1038/ki.2011.213.
  5. Culleton BF, Walsh M, Klarenbach SW, et al. Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life: a randomized controlled trial. JAMA. 2007;298(11):1291-1299. doi:10.1001/jama.298.11.1291.
  6. Weinhandl ED, Liu J, Gilbertson DT, Arneson TJ, Collins AJ. Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. JASN. 2012;23(5):895-904. doi:10.1681/ASN.2011080761.
  7. Weinhandl ED, Gilbertson DT, Collins AJ. Mortality, Hospitalization, and Technique Failure in Daily Home Hemodialysis and Matched Peritoneal Dialysis Patients: A Matched Cohort Study. Am J Kidney Dis. 2016;67(1):98-110. doi:10.1053/j.ajkd.2015.07.014.
  8. Luthje L, Andreas S. Obstructive sleep apnea and coronary artery disease. Sleep Med Rev. 2008;12(1):19-31.
  9. London, G.M., Pannier, B., Guerin, A.P. et al, Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study. J Am Soc Nephrol. 2001;12:2759–2767.