Nocturnal Dialysis Linked with Reduced Left Ventricular Mass
Recipients of in-hospital nighttime dialysis experienced a 14.2 gram reduction in left ventricle thickening.
In-hospital nocturnal hemodialysis (INHD) may be good for patients' hearts, a new study suggests. Compared with conventional hemodialysis (HD), INHD was associated with reduced left ventricular mass (LVM), a marker linked with cardiovascular improvement.
Ron Wald, MD, of St. Michael's Hospital in Toronto, and colleagues compared the change in LVM in 30 conventional HD patients and 37 patients converted to INHD. INHD involved 8-hour dialysis sessions on 3 nights for a weekly total of 24 hours; conventional HD took place for a total of 12 hours.
Over a year, INHD patients experienced a 14.2 gram reduction in LVM, as demonstrated by cardiovascular magnetic resonance imaging. Conventional HD, in contrast, had an increase in LVM. Researchers also observed a trend toward larger reductions in systolic blood pressure (9.8 mm Hg) among INHD patients with fewer antihypertensive medications prescribed over time.
“Hypertension is an important mediator of left ventricular hypertrophy, and improved blood pressure control among INHD recipients likely contribute to LVM regression,” the investigators explained in the Canadian Journal of Cardiology. “It is also possible that intensified dialysis leads to LVM regression by mediating the direct removal or suppressing the production of hypertrophy-promoting substances.”
Serum phosphate concentration declined modestly by 0.40 mmol/L among INHD recipients, but the researchers observed no differences in the patients' requirements for phosphate binders.
Similar reductions in the size of the left ventricle wall have been observed in trials of home nocturnal HD and short-daily HD, the investigators noted.
INHD is a dialysis alternative that also frees up daytime hours for other activities.
Whether improvement in LVM translates to meaningful clinical outcomes remains an open question. Randomized trials with larger numbers of patients and longer follow-up would help clarify the findings and their durability, the investigators noted.