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Long term reduction of cardiovascular risk factors associated with three hour daily dialysis: A prospective, cohort
Steven G Achinger1,2, Juan Carlos Ayus3
1Department of Nephrology, Watson Clinic, LLP, Lakeland, Florida, USA.
Insights
Daily hemodialysis (DHD) offers long-term cardiovascular benefits over conventional hemodialysis (CHD). This study shows DHD significantly reduces blood pressure and improves mineral metabolism and anemia in patients over four years.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Internal Medicine
Background:
- Conventional hemodialysis (CHD) has known effects on cardiovascular risk factors.
- Previous studies indicated short-term benefits of daily hemodialysis (DHD) on left ventricular hypertrophy and mineral metabolism.
- Long-term prospective data on DHD's impact on these cardiovascular risk factors were lacking.
Purpose of the Study:
- To investigate the long-term (4-year) effects of daily hemodialysis (DHD) compared to conventional hemodialysis (CHD) on key cardiovascular risk factors.
- To assess changes in left ventricular mass index (LVMI), blood pressure, hemoglobin, and mineral metabolism.
Main Methods:
- A 4-year prospective cohort study comparing DHD (six 3-hour sessions/week) with CHD (three 4-hour sessions/week).
- Included 26 DHD patients and 51 matched CHD patients, with 15 DHD and 26 CHD completing the 4-year follow-up.
- Measured LVMI, blood pressures, hemoglobin, and mineral metabolism markers.
Main Results:
- DHD patients exhibited significantly lower systolic and diastolic blood pressures at 4 years compared to CHD patients (p < 0.05).
- Fewer DHD patients required anti-hypertensive medication (50% vs. 80%, p < 0.05).
- DHD was associated with better achievement of mineral metabolism goals for phosphorus and calcium-phosphorus product (adjusted HR 3.6, p=0.002 and adjusted HR 3.66, p=0.001, respectively).
- A trend towards lower LVMI was observed in the DHD group (p=0.23), and improvements in hemoglobin persisted.
Conclusions:
- Daily hemodialysis is associated with sustained, long-term improvements in cardiovascular risk factors, including blood pressure, mineral metabolism, and anemia.
- These findings suggest DHD may be a beneficial alternative for managing cardiovascular health in hemodialysis patients.
- Further research could explore the impact of DHD on LVMI and overall cardiovascular outcomes.
Introduction:
Daily hemodialysis (DHD) compared to conventional hemodialysis (CHD) leads to improvements in left ventricular hypertrophy and mineral metabolism at 1-year follow-up. However, there is no information from prospective studies on the long terms effects of DHD on these key cardiovascular risk factors.
Methods:
We conducted a 4 year, prospective cohort study of 26 DHD and 51 matched CHD patients on the effect of DHD (six sessions/week × 3 h) versus CHD (three sessions/week × 4 h), 15 DHD, and 26 CHD patients completed 4-years follow-up. Measures of left ventricular mass index (LVMI), blood pressures, hemoglobin, and mineral metabolism markers were performed.
Results:
Systolic and diastolic blood pressures were significantly lower in the DHD group than the CHD group at 4-year follow-up, 128 mmHg (95% CI, 111-143) versus 148 mmHg (95% CI, 137-158) (p < 0.05) and 60 mmHg (95% CI, 56-63) versus 71 mmHg (95% CI, 64-76) (p < 0.05). DHD was associated with fewer patients taking any anti-hypertensive drug therapy than CHD, 50% versus 80% (p < 0.05). DHD was associated with improved attainment of mineral metabolism goals for phosphorus (adjusted HR 3.6, p = 0.002) and calcium × phosphorus product (adjusted HR 3.66, p = 0.001) at 4-years follow-up compared to CHD. At 4 years, there was a nonsignificant trend toward lower LVMI in the DHD than in the CHD group: 116 g/m2 (95% CI, 97-136) versus 138 g/m2 (95% CI, 115-172) (p = 0.23). Similarly, improvements in hemoglobin also persisted at 4 years follow-up.
Conclusion:
DHD is associated with long-term (4 year) improvements in key cardiovascular risk factors: blood pressure, mineral metabolism, and anemia with trends toward improved LVMI.
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