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Effect of frequent or extended hemodialysis on cardiovascular parameters: a meta-analysis
Paweena Susantitaphong1, Ioannis Koulouridis, Ethan M Balk
1Department of Medicine, Division of Nephrology, Kidney and Dialysis Research Laboratory, St. Elizabeth's Medical Center, Boston, MA 02135, USA.
Insights
More frequent or extended hemodialysis (HD) significantly reduces left ventricular mass index (LVMI) and improves cardiac function in patients with chronic kidney failure. This may offer long-term cardiovascular benefits, though more trials are needed.
Area of Science:
- Nephrology and Cardiology
- Cardiovascular Health in Chronic Kidney Disease
Background:
- Increased left ventricular (LV) mass is a significant risk factor for cardiovascular mortality in patients with chronic kidney failure.
- More frequent or extended hemodialysis (HD) is hypothesized to beneficially impact LV mass.
Purpose of the Study:
- To evaluate the effect of frequent or extended hemodialysis on cardiac morphology and function.
- To assess changes in blood pressure parameters with intensified HD regimens.
Main Methods:
- A meta-analysis of single-arm cohort studies and trials was conducted.
- Searched MEDLINE, Cochrane Central Register, and ClinicalTrials.gov for studies on frequent/extended HD.
- Included studies examining cardiac morphology, function, and blood pressure; excluded hemofiltration, hemodiafiltration, and peritoneal dialysis.
Main Results:
- Frequent or extended HD significantly reduced LV mass index (LVMI) by -31.2 g/m(2) (P < 0.001) in meta-analysis.
- LV ejection fraction improved by 6.7% (P = 0.01), with other cardiac parameters showing similar improvements.
- Significant decreases were observed in systolic, diastolic, and mean blood pressure, along with reduced antihypertensive medication use.
Conclusions:
- Conversion to frequent or extended HD is linked to improved cardiac morphology and function, including LVMI and LV ejection fraction.
- Observed improvements in cardiac parameters and blood pressure may confer long-term cardiovascular benefits.
- Further trials with long-term clinical outcomes are necessary to confirm these benefits.
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.
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