Jochen G Raimann1, Christopher T Chan2, John T Daugirdas3, Thomas Depner4, Tom Greene5, George A Kaysen4, Alan S Kliger6, Peter Kotanko1,7, Brett Larive8, Gerald Beck8, Robert McGregor Lindsay9, Michael V Rocco10, Glenn M Chertow11, Nathan W Levin1,7. 1. Renal Research Institute, New York, New York, USA. 2. University Health Network Toronto, Toronto, Ontario, Canada. 3. University of Illinois College of Medicine, Chicago, Illinois, USA. 4. University of California Davis, Davis, California, USA. 5. University of Utah, Salt Lake City, Utah, USA. 6. Yale New Haven Health System, New Haven, Connecticut, USA. 7. Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA. 8. Cleveland Clinic Foundation, Cleveland, Ohio, USA. 9. Western University, London, Ontario, Canada. 10. Wake Forest School of Medicine, Winston-Salem, North Carolina, USA. 11. Stanford University School of Medicine, Stanford, California, USA.
Abstract
INTRODUCTION: The Frequent Hemodialysis Network (FHN) Daily and Nocturnal trials aimed to compare the effects of hemodialysis (HD) given 6 versus 3 times per week. More frequent in-center HD significantly reduced left-ventricular mass (LVM), with more pronounced effects in patients with low urine volumes. In this study, we aimed to explore another potential effect modifier: the predialysis serum sodium (SNa) and related proxies of plasma tonicity. METHODS: Using data from the FHN Daily and Nocturnal Trials, we compared the effects of frequent HD on LVM among patients stratified by SNa, dialysate-to-predialysis serum-sodium gradient (GNa), systolic and diastolic blood pressure, time-integrated sodium-adjusted fluid load (TIFL), and extracellular fluid volume estimated by bioelectrical impedance analysis. RESULTS: In 197 enrolled subjects in the FHN Daily Trial, the treatment effect of frequent HD on ∆LVM was modified by SNa. When the FHN Daily Trial participants are divided into lower and higher predialysis SNa groups (less and greater than 138 mEq/L), the LVM reduction in the lower group was substantially higher (-28.0 [95% CI -40.5 to -15.4] g) than in the higher predialysis SNa group (-2.0 [95% CI -15.5 to 11.5] g). Accounting for GNa, TIFL also showed more pronounced effects among patients with higher GNa or higher TIFL. Results in the Nocturnal Trial were similar in direction and magnitude but did not reach statistical significance. DISCUSSION/ CONCLUSION: In the FHN Daily Trial, the favorable effects of frequent HD on left-ventricular hypertrophy were more pronounced among patients with lower predialysis SNa and higher GNa and TIFL. Whether these metrics can be used to identify patients most likely to benefit from frequent HD or other dialytic or nondialytic interventions remains to be determined. Prospective, adequately powered studies studying the effect of GNa reduction on mortality and hospitalization are needed.
INTRODUCTION: The Frequent Hemodialysis Network (FHN) Daily and Nocturnal trials aimed to compare the effects of hemodialysis (HD) given 6 versus 3 times per week. More frequent in-center HD significantly reduced left-ventricular mass (LVM), with more pronounced effects in patients with low urine volumes. In this study, we aimed to explore another potential effect modifier: the predialysis serum sodium (SNa) and related proxies of plasma tonicity. METHODS: Using data from the FHN Daily and Nocturnal Trials, we compared the effects of frequent HD on LVM among patients stratified by SNa, dialysate-to-predialysis serum-sodium gradient (GNa), systolic and diastolic blood pressure, time-integrated sodium-adjusted fluid load (TIFL), and extracellular fluid volume estimated by bioelectrical impedance analysis. RESULTS: In 197 enrolled subjects in the FHN Daily Trial, the treatment effect of frequent HD on ∆LVM was modified by SNa. When the FHN Daily Trial participants are divided into lower and higher predialysis SNa groups (less and greater than 138 mEq/L), the LVM reduction in the lower group was substantially higher (-28.0 [95% CI -40.5 to -15.4] g) than in the higher predialysis SNa group (-2.0 [95% CI -15.5 to 11.5] g). Accounting for GNa, TIFL also showed more pronounced effects among patients with higher GNa or higher TIFL. Results in the Nocturnal Trial were similar in direction and magnitude but did not reach statistical significance. DISCUSSION/ CONCLUSION: In the FHN Daily Trial, the favorable effects of frequent HD on left-ventricular hypertrophy were more pronounced among patients with lower predialysis SNa and higher GNa and TIFL. Whether these metrics can be used to identify patients most likely to benefit from frequent HD or other dialytic or nondialytic interventions remains to be determined. Prospective, adequately powered studies studying the effect of GNa reduction on mortality and hospitalization are needed.
Authors: Jochen G Raimann; Fansan Zhu; Jack Wang; Stephan Thijssen; Martin K Kuhlmann; Peter Kotanko; Nathan W Levin; George A Kaysen Journal: Kidney Int Date: 2013-09-25 Impact factor: 10.612
Authors: Salustiano Araujo; Helton P Lemes; Danny A Cunha; Vinicius S Queiroz; Daniela D Nascimento; Sebastião Rodrigues Ferreira Filho Journal: J Bras Nefrol Date: 2011-03
Authors: Michael V Rocco; Robert S Lockridge; Gerald J Beck; Paul W Eggers; Jennifer J Gassman; Tom Greene; Brett Larive; Christopher T Chan; Glenn M Chertow; Michael Copland; Christopher D Hoy; Robert M Lindsay; Nathan W Levin; Daniel B Ornt; Andreas Pierratos; Mary F Pipkin; Sanjay Rajagopalan; John B Stokes; Mark L Unruh; Robert A Star; Alan S Kliger; A Kliger; P Eggers; J Briggs; T Hostetter; A Narva; R Star; B Augustine; P Mohr; G Beck; Z Fu; J Gassman; T Greene; J Daugirdas; L Hunsicker; B Larive; M Li; J Mackrell; K Wiggins; S Sherer; B Weiss; S Rajagopalan; J Sanz; S Dellagrottaglie; M Kariisa; T Tran; J West; M Unruh; R Keene; J Schlarb; C Chan; M McGrath-Chong; R Frome; H Higgins; S Ke; O Mandaci; C Owens; C Snell; G Eknoyan; L Appel; A Cheung; A Derse; C Kramer; N Geller; R Grimm; L Henderson; S Prichard; E Roecker; M Rocco; B Miller; J Riley; R Schuessler; R Lockridge; M Pipkin; C Peterson; C Hoy; A Fensterer; D Steigerwald; J Stokes; D Somers; A Hilkin; K Lilli; W Wallace; B Franzwa; E Waterman; C Chan; M McGrath-Chong; M Copland; A Levin; L Sioson; E Cabezon; S Kwan; D Roger; R Lindsay; R Suri; J Champagne; R Bullas; A Garg; A Mazzorato; E Spanner; M Rocco; J Burkart; S Moossavi; V Mauck; T Kaufman; A Pierratos; W Chan; K Regozo; S Kwok Journal: Kidney Int Date: 2011-07-20 Impact factor: 10.612
Authors: Mark L Unruh; Brett Larive; Glenn M Chertow; Paul W Eggers; Amit X Garg; Jennifer Gassman; Maria Tarallo; Fredric O Finkelstein; Paul L Kimmel Journal: Am J Kidney Dis Date: 2013-01-15 Impact factor: 8.860
Authors: ZiMian Wang; Marie-Pierre St-Onge; Beatriz Lecumberri; F Xavier Pi-Sunyer; Stanley Heshka; Jack Wang; Donald P Kotler; Dympna Gallagher; Lucian Wielopolski; Richard N Pierson; Steven B Heymsfield Journal: Am J Physiol Endocrinol Metab Date: 2003-10-07 Impact factor: 4.310
Authors: Christopher T Chan; Tom Greene; Glenn M Chertow; Alan S Kliger; John B Stokes; Gerald J Beck; John T Daugirdas; Peter Kotanko; Brett Larive; Nathan W Levin; Ravindra L Mehta; Michael Rocco; Javier Sanz; Phillip C Yang; Sanjay Rajagopalan Journal: Clin J Am Soc Nephrol Date: 2013-08-22 Impact factor: 8.237
Authors: John T Daugirdas; Tom Greene; Michael V Rocco; George A Kaysen; Thomas A Depner; Nathan W Levin; Glenn M Chertow; Daniel B Ornt; Jochen G Raimann; Brett Larive; Alan S Kliger Journal: Kidney Int Date: 2013-01-23 Impact factor: 10.612