Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis
TL;DR: Reductions in BP with NHD are accompanied by regression of LVH, and there was no relationship between changes in LVMI and changes in BP or Hb in the CHD cohort.
About: This article is published in Kidney International.The article was published on 2002-06-01 and is currently open access. It has received 360 citations till now. The article focuses on the topics: Left ventricular hypertrophy & End stage renal disease.
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TL;DR: Cardiovascular Disease in Dialysis Patients Tables: An Overview of Epidemiology of Cardiovascular disease in Children and Work Group Members and Foreword.
1,258 citations
TL;DR: This preliminary study revealed that frequent nocturnal hemodialysis improved left ventricular mass, reduced the need for blood pressure medications, improved some measures of mineral metabolism, and improved selected measures of quality of life.
Abstract: ContextMorbidity and mortality rates in hemodialysis patients remain excessive. Alterations in the delivery of dialysis may lead to improved patient outcomes.ObjectiveTo compare the effects of frequent nocturnal hemodialysis vs conventional hemodialysis on change in left ventricular mass and health-related quality of life over 6 months.Design, Setting, and ParticipantsA 2-group, parallel, randomized controlled trial conducted at 2 Canadian university centers between August 2004 and December 2006. A total of 52 patients undergoing hemodialysis were recruited.InterventionParticipants were randomly assigned in a 1:1 ratio to receive nocturnal hemodialysis 6 times weekly or conventional hemodialysis 3 times weekly.Main Outcome MeasuresThe primary outcome was change in left ventricular mass, as measured by cardiovascular magnetic resonance imaging. The secondary outcomes were patient-reported quality of life, blood pressure, mineral metabolism, and use of medications.ResultsFrequent nocturnal hemodialysis significantly improved the primary outcome (mean left ventricular mass difference between groups, 15.3 g, 95% confidence interval [CI], 1.0 to 29.6 g; P = .04). Frequent nocturnal hemodialysis did not significantly improve quality of life (difference of change in EuroQol 5-D index from baseline, 0.05; 95% CI, −0.07 to 0.17; P = .43). However, frequent nocturnal hemodialysis was associated with clinically and statistically significant improvements in selected kidney-specific domains of quality of life (P = .01 for effects of kidney disease and P = .02 for burden of kidney disease). Frequent nocturnal hemodialysis was also associated with improvements in systolic blood pressure (P = .01 after adjustment) and mineral metabolism, including a reduction in or discontinuation of antihypertensive medications (16/26 patients in the nocturnal hemodialysis group vs 3/25 patients in the conventional hemodialysis group; P < .001) and oral phosphate binders (19/26 patients in the nocturnal hemodialysis group vs 3/25 patients in the conventional dialysis group; P < .001). No benefit in anemia management was seen with nocturnal hemodialysis.ConclusionThis preliminary study revealed that, compared with conventional hemodialysis (3 times weekly), frequent nocturnal hemodialysis improved left ventricular mass, reduced the need for blood pressure medications, improved some measures of mineral metabolism, and improved selected measures of quality of life.Trial Registrationisrctn.org Identifier: ISRCTN25858715
670 citations
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Wake Forest University1, University of Virginia2, Cleveland Clinic3, University of Utah4, University Health Network5, Stanford University6, University of California, San Francisco7, University of British Columbia8, University of Western Ontario9, Case Western Reserve University10, Humber River Regional Hospital11, Ohio State University12, University of Iowa13, University of Pittsburgh14, Yale University15
TL;DR: Patients in the nocturnal arm had improved control of hyperphosphatemia and hypertension, but no significant benefit among the other main secondary outcomes.
446 citations
TL;DR: The authors explore the most important interactions between heart rhythm disorders and renal dysfunction while evaluating the ways in which the coexistence of renal dysfunction and cardiac arrhythmia influences the management of both.
Abstract: Patients with chronic kidney disease (CKD) exhibit an elevated cardiovascular risk manifesting as coronary artery disease, heart failure, arrhythmias, and sudden cardiac death. Although the inciden...
436 citations
TL;DR: In this paper, the authors summarized available knowledge on the role of the sympathetic nervous system in the pathogenesis of renal hypertension, its clinical relevance, and the consequences of this knowledge for the choice of treatment.
266 citations
Cites background from "Regression of left ventricular hype..."
...It was already shown that intensifying the dialysis regimen has a profound impact on blood pressure, presumably by its effect on peripheral vascular resistance [42–45]....
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References
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TL;DR: The best method for LVM-E identified combined cube function geometry with a modified convention for determination of left ventricular internal dimension (LVID), posterior wall thickness (PWT), and interventricular septal thickness (IVST), which excluded the thickness of endocardial echo lines from wall thicknesses and included the thickness in LVID.
Abstract: An accurte echocardiographic (E) method for determination of left ventricular mass (LVM) was derived from systematic analysis of the relationship between the antemortem left ventricular echogram and postmortem anatomic LVM in 34 adults with a wide range of anatomic LVM (101-505 g). No subject had massive myocardial infarction, ventricular aneurysm, severe right ventricular volume overload or hypertrophic cardiography. The best method for LVM-E identified combined cube function geometry with a modified convention for determination of left ventricular internal dimension (LVID), posterior wall thickness (PWT), and interventricular septal thickness (IVST), which excluded the thickness of endocardial echo lines from wall thicknesses and included the thickness of left septal and posterior wall endocardial echo lines in LVID (Penn Convention, P). By this method, anatomic LVM = 1.04 ([LVIDp + PWTp + IVSTp]3--[LVIDp]3) -- 14 g; r = 0.96, SD= 29 g, N= 34. Standard echo measurements gave less accurate results, as did previously reported methods for LVM-E. LVM-Dp is an accurate, widely applicable method for the study of left ventricular hypertrophy.
4,515 citations
TL;DR: Correspondence of left ventricular mass in concentric remodeling appeared to reflect offsetting by volume "underload" of the effects of pressure overload, whereas eccentric hypertrophy was associated with concomitant pressure and volume overload.
1,519 citations
TL;DR: It is concluded that clinical and echocardiographic cardiovascular disease are already present in a very high proportion of patients starting ESRD therapy and are independent mortality factors.
1,255 citations
TL;DR: Until outcome guided criteria for LV hypertrophy are developed, application of sex-specific criteria based on a healthy population distribution of LV mass offer the best approach to echocardiographic diagnosis of LVhypertrophy.
Abstract: Of 6,148 original cohort and offspring subjects of the Framingham Heart Study who underwent routine evaluation, a healthy group of 347 men (aged 42 ± 12 years) and 517 women (aged 43 ± 12 years) was identified to develop echocardiographic criteria for left ventricular (LV) hypertrophy. Healthy subjects were defined as normotensive, receiving no cardiac or antihypertensive medications, nonobese and free of cardiopulmonary disease. Echocardiographic criteria (in accordance with the American Society of Echocardiography convention) for LV hypertrophy, based on mean plus 2 standard deviations for LV mass, LV mass corrected for body surface area and LV mass corrected for height in this healthy sample are, respectively: 294 g, 150 g/m2 and 163 g/m In men and 198 g, 120 g/m2 and 121 g/m in women. Criteria based on LV mass/height result in higher prevalence rates of LV hypertrophy than LV mass/body surface area while still correctIng for body size. The prevalence of LV hypertrophy in the entire study population (using LV mass/height criteria) is 16% in men and 19% in women. Until outcome guided criteria for LV hypertrophy are developed, application of sex-specific criteria based on a healthy population distribution of LV mass offer the best approach to echocardiographic diagnosis of LV hypertrophy.
832 citations
TL;DR: Left ventricular hypertrophy appears to be an important, independent, determinant of survival in patients receiving therapy for end-stage renal failure in patients beginning renal replacement therapy.
785 citations