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Association between conversion to in-center nocturnal hemodialysis and right ventricular remodeling.

ABSTRACT: Background:In-center nocturnal hemodialysis (INHD) is associated with favorable left ventricular (LV) remodeling. Although right ventricular (RV) structure and function carry prognostic significance, the impact of dialysis intensification on RV is unknown. Our objectives were to evaluate changes in RV mass index (MI), end-diastolic volume index (EDVI), end-systolic volume index (ESVI) and ejection fraction (EF) after conversion to INHD and their relationship with LV remodeling. Methods:Of 67 conventional hemodialysis (CHD, 4?h/session, three times/week) patients, 30 continued on CHD and 37 converted to INHD (7-8?h/session, three times/week). Cardiac magnetic resonance imaging was performed at baseline and 1?year using a standardized protocol; an experienced and blinded reader performed RV measurements. Results:At 1?year there were significant reductions in RVMI {-2.1?g/m2 [95% confidence interval (CI) -3.8 to?-?0.4], P?=?0.017}, RVEDVI [-9.5?mL/m2 (95% CI?-?16.3 to?-?2.6), P?=?0.008] and RVESVI [-6.2?mL/m2 (95% CI?-?10.9 to?-?1.6), P?=?0.011] in the INHD group; no significant changes were observed in the CHD group. Between-group comparisons showed significantly greater reduction of RVESVI [-7.9?mL/m2 (95% CI?-?14.9 to?-?0.9), P?=?0.03] in the INHD group, a nonsignificant trend toward greater reduction in RVEDVI and no significant difference in RVMI and RVEF changes. There was significant correlation between LV and RV in terms of changes in mass index (MI) (r?=?0.46), EDVI (r?=?0.73), ESVI (r?=?0.7) and EF (r?=?0.38) over 1?year (all P?

SUBMITTER: Karur GR

PROVIDER: S-EPMC5982781 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Association between conversion to in-center nocturnal hemodialysis and right ventricular remodeling.

Karur Gauri R GR Wald Ron R Goldstein Marc B MB Wald Rachel R Jimenez-Juan Laura L Kiaii Mercedeh M Leipsic Jonathon J Kirpalani Anish A Bello Olugbenga O Barthur Ashita A Ng Ming-Yen MY Deva Djeven P DP Yan Andrew T AT

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 20180601 6

<h4>Background</h4>In-center nocturnal hemodialysis (INHD) is associated with favorable left ventricular (LV) remodeling. Although right ventricular (RV) structure and function carry prognostic significance, the impact of dialysis intensification on RV is unknown. Our objectives were to evaluate changes in RV mass index (MI), end-diastolic volume index (EDVI), end-systolic volume index (ESVI) and ejection fraction (EF) after conversion to INHD and their relationship with LV remodeling.<h4>Method ...[more]

PMID: 28992094

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Project description:Background and objectivesHigher 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, & measurementsThe 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 volume was 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.ResultsIn the daily trial, frequent hemodialysis resulted in significant reductions in left ventricular end diastolic volume (-11.0% [95% confidence interval, -16.1% to -5.5%]), left ventricular end systolic volume (-14.8% [-22.7% to -6.2%]), right ventricular end diastolic volume (-11.6% [-19.0% to -3.6%]), and a trend for right ventricular end systolic volume (-11.3% [-21.4% to 0.1%]) compared with conventional therapy. The magnitude 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.ConclusionsFrequent 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.

Dataset Information

Association between conversion to in-center nocturnal hemodialysis and right ventricular remodeling.

Publications

Association between conversion to in-center nocturnal hemodialysis and right ventricular remodeling.

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