title: Cardiac and vascular structure and function parameters do not improve with alternate nightly home hemodialysis: an interventional cohort study.
abstract: BACKGROUND
  Nightly extended hours hemodialysis may improve left ventricular hypertrophy and function and endothelial function but presents problems of sustainability and increased cost. The effect of alternate nightly home hemodialysis (NHD) on cardiovascular structure and function is not known.
  
  
  METHODS
  Sixty-three patients on standard hemodialysis (SHD: 3.5-6 hours/session, 3-5 sessions weekly) converted to NHD (6-10 hours/session overnight for 3-5 sessions weekly). 2Dimensional transthoracic echocardiography and ultrasound measures of brachial artery reactivity (BAR), carotid intima-media thickness (CIMT), total arterial compliance (TAC) and augmentation index (AIX) were performed post dialysis at baseline and 18-24 months following conversion to NHD. In 37 patients, indices of oxidative stress: plasma malonyldialdehyde (MDA) and anti-oxidant enzymes: catalase (CAT), glutathione peroxidase (GPX) and superoxide dismutase (SOD) activity and total antioxidant status (TAS) were measured at baseline, 3 and 6 months.
  
  
  RESULTS
  Left ventricular mass index (LVMI) remained stable. Despite significant derangement at baseline, there were no changes in diastolic function measures, CIMT, BAR and TAC. AIX increased. Conversion to NHD improved bone mineral metabolism parameters and blood pressure control. Interdialytic weight gains increased. No definite improvements in measures of oxidative stress were demonstrated.
  
  
  CONCLUSIONS
  Despite improvement in uremic toxin levels and some cardiovascular risk factors, conversion to an alternate nightly NHD regimen did not improve cardiovascular structure and function. Continuing suboptimal control of uremic toxins and interdialytic weight gains may be a possible explanation. This study adds to the increasing uncertainty about the nature of improvement in cardiovascular parameters with conversion to intensive hemodialysis regimens. Future randomized controlled trials will be important to determine whether increases in dialysis session duration, frequency or both are most beneficial for improving cardiovascular disease whilst minimizing costs and the impact of dialysis on quality of life.
authors.affiliation: Department of Nephrology Princess Alexandra Hospital, Ipswich Rd, Brisbane, 4102, Australia. Carolyn_van_Eps@health.qld.gov.au
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: van Eps
authors.forename: Leanne
authors.initials: L
authors.lastname: Jeffriess
authors.forename: Brian
authors.initials: B
authors.lastname: Haluska
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Coombes
authors.forename: Aya
authors.initials: A
authors.lastname: Matsumoto
authors.forename: Janine K
authors.initials: JK
authors.lastname: Jeffries
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Scott B
authors.initials: SB
authors.lastname: Campbell
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Isbel
authors.forename: David W
authors.initials: DW
authors.lastname: Mudge
authors.forename: Thomas
authors.initials: T
authors.lastname: Marwick
mesh_terms: D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D001916:Brachial Artery / Q000502:physiology; D059168:Carotid Intima-Media Thickness; D002940:Circadian Rhythm / Q000502:physiology; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006437:Hemodialysis, Home / Q000379:methods* / Q000592:standards*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000502:physiology; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D017211:Treatment Failure; D014511:Uremia / Q000453:epidemiology / Q000628:therapy