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Cardiac and vascular structure and function parameters do not improve with alternate nightly home hemodialysis: an

Carolyn L van Eps1, Leanne Jeffriess, Brian Haluska

  • 1Department of Nephrology Princess Alexandra Hospital, Ipswich Rd, Brisbane, 4102, Australia. Carolyn_van_Eps@health.qld.gov.au

BMC Nephrology
|October 4, 2011
PubMed

Insights

Alternate nightly home hemodialysis (NHD) did not improve cardiovascular structure or function in patients despite better blood pressure control. Further research is needed to optimize intensive hemodialysis for cardiovascular health.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Dialysis Therapy

Background:

  • Extended hours hemodialysis may benefit cardiovascular health but faces sustainability and cost challenges.
  • The impact of alternate nightly home hemodialysis (NHD) on cardiovascular structure and function remains unclear.

Purpose of the Study:

  • To evaluate the effect of converting from standard hemodialysis (SHD) to NHD on cardiovascular structure and function.
  • To assess changes in endothelial function, arterial stiffness, and oxidative stress markers.

Main Methods:

  • Sixty-three patients switched from SHD to NHD (6-10 hours/session, 3-5 times/week).
  • Cardiovascular parameters (echocardiography, BAR, CIMT, TAC, AIX) and oxidative stress markers (MDA, CAT, GPX, SOD, TAS) were measured at baseline and follow-up.

Main Results:

  • Left ventricular mass index (LVMI) remained stable; no significant changes in diastolic function, CIMT, BAR, or TAC were observed.
  • Augmentation index (AIX) increased, indicating worsening arterial stiffness.
  • NHD improved bone mineral metabolism and blood pressure control, but interdialytic weight gains increased.

Conclusions:

  • Conversion to NHD did not improve cardiovascular structure and function, despite improvements in uremic toxin control and some risk factors.
  • Suboptimal control of uremic toxins and interdialytic weight gains may explain the lack of benefit.
  • Further randomized trials are needed to determine optimal dialysis regimens for cardiovascular health and quality of life.
Abstract

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