Ron Wald1, Marc B Goldstein2, Jeffrey Perl2, Mercedeh Kiaii3, Darren Yuen2, Rachel M Wald4, Ziv Harel2, Jordan J Weinstein2, Baruch Jakubovic5, Howard Leong-Poi6, Anish Kirpalani7, Jonathon Leipsic8, Niki Dacouris5, Myles Wolf9, Andrew T Yan6. 1. Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada. Electronic address: waldr@smh.ca. 2. Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada. 3. Division of Nephrology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada. 4. Divisions of Cardiology and Medical Imaging, University Health Network, Toronto, Ontario, Canada. 5. Division of Nephrology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada. 6. Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Division of Cardiology, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada. 7. Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada. 8. Department of Radiology and Division of Cardiology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada. 9. Division of Nephrology and Center for Translational Metabolism and Health - Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Abstract
BACKGROUND: In-centre nocturnal hemodialysis (INHD, 7-8 hours/session, 3 times/week) is an increasingly utilized form of dialysis intensification, though data on the cardiovascular benefits of this modality are limited. METHODS: In this prospective cohort study, we enrolled 67 prevalent conventional hemodialysis (CHD, 4 hours/session, 3 times/week) recipients at 2 medical centres in Canada, of whom 37 converted to INHD and 30 remained on CHD. The primary outcome was the change in left ventricular mass (LVM) after 1 year as assessed by cardiac magnetic resonance imaging. Secondary outcomes included changes in serum phosphate concentration, phosphate binder burden, haemoglobin, erythropoiesis stimulating agent usage, and blood pressure. RESULTS: Conversion to INHD was associated with a 14.2 (95% confidence interval [CI] 1.2-27.2) g reduction in LVM as compared with continuation on CHD. This result was maintained after adjustment for baseline imbalances between the groups and in ancillary analyses. There was a trend toward a larger drop in systolic blood pressure (9.8 [95% CI, -1.4-20.9] mm Hg) among INHD recipients with a significant reduction in the number of prescribed antihypertensive agents (0.7 [95% CI, 0.3-1.1] agents). Serum phosphate declined by 0.40 (95% CI, 0.16-0.63) mmol/L among INHD recipients without any difference in calcium-based phosphate binder requirements, as compared with those who remained on CHD. CONCLUSIONS: Compared with continuation of CHD, conversion to INHD was associated with significant LVM regression and reduction in serum phosphate concentration at 1 year.
RCT Entities:
BACKGROUND: In-centre nocturnal hemodialysis (INHD, 7-8 hours/session, 3 times/week) is an increasingly utilized form of dialysis intensification, though data on the cardiovascular benefits of this modality are limited. METHODS: In this prospective cohort study, we enrolled 67 prevalent conventional hemodialysis (CHD, 4 hours/session, 3 times/week) recipients at 2 medical centres in Canada, of whom 37 converted to INHD and 30 remained on CHD. The primary outcome was the change in left ventricular mass (LVM) after 1 year as assessed by cardiac magnetic resonance imaging. Secondary outcomes included changes in serum phosphate concentration, phosphate binder burden, haemoglobin, erythropoiesis stimulating agent usage, and blood pressure. RESULTS: Conversion to INHD was associated with a 14.2 (95% confidence interval [CI] 1.2-27.2) g reduction in LVM as compared with continuation on CHD. This result was maintained after adjustment for baseline imbalances between the groups and in ancillary analyses. There was a trend toward a larger drop in systolic blood pressure (9.8 [95% CI, -1.4-20.9] mm Hg) among INHD recipients with a significant reduction in the number of prescribed antihypertensive agents (0.7 [95% CI, 0.3-1.1] agents). Serum phosphate declined by 0.40 (95% CI, 0.16-0.63) mmol/L among INHD recipients without any difference in calcium-based phosphate binder requirements, as compared with those who remained on CHD. CONCLUSIONS: Compared with continuation of CHD, conversion to INHD was associated with significant LVM regression and reduction in serum phosphate concentration at 1 year.
Authors: Nazanin Noori; Andrew T Yan; Mercedeh Kiaii; Andrea Rathe; Marc B Goldstein; Olugbenga Bello; Ron Wald Journal: Int Urol Nephrol Date: 2017-04-29 Impact factor: 2.370
Authors: Tamryn K Law; Ron Wald; Marc Goldstein; Gauri R Karur; Ming-Yen Ng; Angela Y M Wang; Djeven P Deva; Anish Kirpalani; Rachel M Wald; Mercedeh Kiaii; Jonathon Leipsic; Kim A Connelly; Andrew T Yan Journal: J Nephrol Date: 2018-08-24 Impact factor: 3.902
Authors: Jeffrey Perl; Sahir Kalim; Ron Wald; Marc B Goldstein; Andrew T Yan; Nazanin Noori; Mercedeh Kiaii; Julia Wenger; Christopher Chan; Ravi I Thadhani; S Ananth Karumanchi; Anders H Berg Journal: Hemodial Int Date: 2016-06-21 Impact factor: 1.812
Authors: Gauri R Karur; Ron Wald; Marc B Goldstein; Rachel Wald; Laura Jimenez-Juan; Mercedeh Kiaii; Jonathon Leipsic; Anish Kirpalani; Olugbenga Bello; Ashita Barthur; Ming-Yen Ng; Djeven P Deva; Andrew T Yan Journal: Nephrol Dial Transplant Date: 2018-06-01 Impact factor: 5.992
Authors: Sahir Kalim; Ron Wald; Andrew T Yan; Marc B Goldstein; Mercedeh Kiaii; Dihua Xu; Anders H Berg; Clary Clish; Ravi Thadhani; Eugene P Rhee; Jeffrey Perl Journal: Clin J Am Soc Nephrol Date: 2018-02-14 Impact factor: 8.237
Authors: Sean Cai; Ron Wald; Djeven P Deva; Mercedeh Kiaii; Ming-Yen Ng; Gauri R Karur; Oblugbenga Bello; Zhuo Jun Li; Jonathon Leipsic; Laura Jimenez-Juan; Anish Kirpalani; Kim A Connelly; Andrew T Yan Journal: J Nephrol Date: 2019-11-14 Impact factor: 3.902