BACKGROUND: Increased left ventricular (LV) mass is a risk factor for cardiovascular mortality in patients with chronic kidney failure. More frequent or extended hemodialysis (HD) has been hypothesized to have a beneficial effect on LV mass. STUDY DESIGN: Meta-analysis. SETTING & POPULATION: MEDLINE literature search (inception to April 2011), Cochrane Central Register of Controlled Trials and ClinicalTrials.gov using the search terms "short daily HD," "daily HD," "quotidian HD," "frequent HD," "intensive HD," "nocturnal HD," and "home HD." SELECTION CRITERIA FOR STUDIES: Single-arm cohort studies (with pre- and post-study evaluations) and trials examining the effect of frequent or extended HD on cardiac morphology and function and blood pressure parameters. Studies of hemofiltration, hemodiafiltration, and peritoneal dialysis were excluded. INTERVENTION: Frequent (2-8 hours, >3 times weekly) or extended (>4 hours, 3 times weekly) HD compared with conventional (≤4 hours, 3 times weekly) HD. OUTCOMES: Absolute changes in cardiac morphology and function, including LV mass index (LVMI; primary) and blood pressure parameters (secondary). RESULTS: We identified 38 single-arm studies, 5 crossover trials, and 3 randomized controlled trials. By meta-analysis of 23 study arms, frequent or extended HD significantly reduced LVMI from baseline (-31.2 g/m(2), 95% CI, -39.8 to -22.5; P < 0.001). The 3 randomized trials found a less pronounced net reduction in LVMI (-7.0 g/m(2); 95% CI, -10.2 to -3.7; P < 0.001). LV ejection fraction improved by 6.7% (95% CI, 1.6% to 11.9%; P = 0.01). Other cardiac morphologic parameters showed similar improvements. There also were significant decreases in systolic, diastolic, and mean blood pressure and mean number of antihypertensive medications. LIMITATIONS: Paucity of randomized controlled trials. CONCLUSIONS: Conversion from conventional to frequent or extended HD is associated with improvements in cardiac morphology and function, including LVMI and LV ejection fraction, respectively, and several blood pressure parameters, which collectively might confer long-term cardiovascular benefit. Trials with long-term clinical outcomes are needed.
BACKGROUND: Increased left ventricular (LV) mass is a risk factor for cardiovascular mortality in patients with chronic kidney failure. More frequent or extended hemodialysis (HD) has been hypothesized to have a beneficial effect on LV mass. STUDY DESIGN: Meta-analysis. SETTING & POPULATION: MEDLINE literature search (inception to April 2011), Cochrane Central Register of Controlled Trials and ClinicalTrials.gov using the search terms "short daily HD," "daily HD," "quotidian HD," "frequent HD," "intensive HD," "nocturnal HD," and "home HD." SELECTION CRITERIA FOR STUDIES: Single-arm cohort studies (with pre- and post-study evaluations) and trials examining the effect of frequent or extended HD on cardiac morphology and function and blood pressure parameters. Studies of hemofiltration, hemodiafiltration, and peritoneal dialysis were excluded. INTERVENTION: Frequent (2-8 hours, >3 times weekly) or extended (>4 hours, 3 times weekly) HD compared with conventional (≤4 hours, 3 times weekly) HD. OUTCOMES: Absolute changes in cardiac morphology and function, including LV mass index (LVMI; primary) and blood pressure parameters (secondary). RESULTS: We identified 38 single-arm studies, 5 crossover trials, and 3 randomized controlled trials. By meta-analysis of 23 study arms, frequent or extended HD significantly reduced LVMI from baseline (-31.2 g/m(2), 95% CI, -39.8 to -22.5; P < 0.001). The 3 randomized trials found a less pronounced net reduction in LVMI (-7.0 g/m(2); 95% CI, -10.2 to -3.7; P < 0.001). LV ejection fraction improved by 6.7% (95% CI, 1.6% to 11.9%; P = 0.01). Other cardiac morphologic parameters showed similar improvements. There also were significant decreases in systolic, diastolic, and mean blood pressure and mean number of antihypertensive medications. LIMITATIONS: Paucity of randomized controlled trials. CONCLUSIONS: Conversion from conventional to frequent or extended HD is associated with improvements in cardiac morphology and function, including LVMI and LV ejection fraction, respectively, and several blood pressure parameters, which collectively might confer long-term cardiovascular benefit. Trials with long-term clinical outcomes are needed.
Authors: Amy W Williams; Srivasa B Chebrolu; Todd S Ing; George Ting; Christopher R Blagg; Zbylut J Twardowski; Yalem Woredekal; Barbara Delano; Vasant C Gandhi; Carl M Kjellstrand Journal: Am J Kidney Dis Date: 2004-01 Impact factor: 8.860
Authors: Allan J Collins; Robert N Foley; Charles Herzog; Blanche Chavers; David Gilbertson; Areef Ishani; Bertram Kasiske; Jiannong Liu; Lih-Wen Mau; Marshall McBean; Anne Murray; Wendy St Peter; Haifeng Guo; Sally Gustafson; Qi Li; Shuling Li; Suying Li; Yi Peng; Yang Qiu; Tricia Roberts; Melissa Skeans; Jon Snyder; Craig Solid; Changchun Wang; Eric Weinhandl; David Zaun; Cheryl Arko; Shu-Cheng Chen; Frederick Dalleska; Frank Daniels; Stephan Dunning; James Ebben; Eric Frazier; Christopher Hanzlik; Roger Johnson; Daniel Sheets; Xinyue Wang; Beth Forrest; Edward Constantini; Susan Everson; Paul Eggers; Lawrence Agodoa Journal: Am J Kidney Dis Date: 2011-01 Impact factor: 8.860
Authors: Ingegerd Odar-Cederlöf; Per Bjellerup; Amy Williams; Christopher R Blagg; Zbylut Twardowski; George Ting; Carl M Kjellstrand Journal: Hemodial Int Date: 2006-10 Impact factor: 1.812
Authors: Sascha David; Philipp Kümpers; Georg M Eisenbach; Hermann Haller; Jan T Kielstein Journal: Nephrol Dial Transplant Date: 2009-02-10 Impact factor: 5.992
Authors: Irina M Mostovaya; Michiel L Bots; Marinus A van den Dorpel; Muriel P C Grooteman; Otto Kamp; Renée Levesque; Piet M Ter Wee; Menso J Nubé; Peter J Blankestijn Journal: Clin J Am Soc Nephrol Date: 2014-01-09 Impact factor: 8.237