The evidence is clear: intensive hemodialysis reduces left ventricular hypertrophy and may reduce risk of cardiovascular complications
Cardiovascular death is significantly more likely in dialysis patients than in age-matched, community-dwelling adults in the U.S., 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.
