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BMC Nephrology
Published in: BMC Nephrology 1/2011

Open Access 01-12-2011 | Research article

Cardiac and vascular structure and function parameters do not improve with alternate nightly home hemodialysis: An interventional cohort study

Authors: Carolyn L van Eps, Leanne Jeffriess, Brian Haluska, Carmel M Hawley, Jeffrey Coombes, Aya Matsumoto, Janine K Jeffries, David W Johnson, Scott B Campbell, Nicole M Isbel, David W Mudge, Thomas Marwick

Published in: BMC Nephrology | Issue 1/2011

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Abstract

Background

Nightly extended hours hemodialysis may improve left ventricular hypertrophy and function and endothelial function but presents problems of sustainability and increased cost. The effect of alternate nightly home hemodialysis (NHD) on cardiovascular structure and function is not known.

Methods

Sixty-three patients on standard hemodialysis (SHD: 3.5-6 hours/session, 3-5 sessions weekly) converted to NHD (6-10 hours/session overnight for 3-5 sessions weekly). 2Dimensional transthoracic echocardiography and ultrasound measures of brachial artery reactivity (BAR), carotid intima-media thickness (CIMT), total arterial compliance (TAC) and augmentation index (AIX) were performed post dialysis at baseline and 18-24 months following conversion to NHD. In 37 patients, indices of oxidative stress: plasma malonyldialdehyde (MDA) and anti-oxidant enzymes: catalase (CAT), glutathione peroxidase (GPX) and superoxide dismutase (SOD) activity and total antioxidant status (TAS) were measured at baseline, 3 and 6 months.

Results

Left ventricular mass index (LVMI) remained stable. Despite significant derangement at baseline, there were no changes in diastolic function measures, CIMT, BAR and TAC. AIX increased. Conversion to NHD improved bone mineral metabolism parameters and blood pressure control. Interdialytic weight gains increased. No definite improvements in measures of oxidative stress were demonstrated.

Conclusions

Despite improvement in uremic toxin levels and some cardiovascular risk factors, conversion to an alternate nightly NHD regimen did not improve cardiovascular structure and function. Continuing suboptimal control of uremic toxins and interdialytic weight gains may be a possible explanation. This study adds to the increasing uncertainty about the nature of improvement in cardiovascular parameters with conversion to intensive hemodialysis regimens. Future randomized controlled trials will be important to determine whether increases in dialysis session duration, frequency or both are most beneficial for improving cardiovascular disease whilst minimizing costs and the impact of dialysis on quality of life.
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Metadata
Title
Cardiac and vascular structure and function parameters do not improve with alternate nightly home hemodialysis: An interventional cohort study
Authors
Carolyn L van Eps
Leanne Jeffriess
Brian Haluska
Carmel M Hawley
Jeffrey Coombes
Aya Matsumoto
Janine K Jeffries
David W Johnson
Scott B Campbell
Nicole M Isbel
David W Mudge
Thomas Marwick
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2011
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/1471-2369-12-51

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Keynote webinar | Spotlight on medication adherence

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WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

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