title: Regression of left ventricular mass following conversion from conventional hemodialysis to thrice weekly in-centre nocturnal hemodialysis.
abstract: BACKGROUND
  Increased left ventricular mass (LVM) is associated with adverse outcomes in patients receiving chronic hemodialysis. Among patients receiving conventional hemodialysis (CHD, 3×/week, 4 hrs/session), we evaluated whether dialysis intensification with in-centre nocturnal hemodialysis (INHD, 3×/week, 7-8 hrs/session in the dialysis unit) was associated with regression of LVM.
  
  
  METHODS
  We conducted a retrospective cohort study of CHD recipients who converted to INHD and received INHD for at least 6 months. LVM on the first echocardiogram performed at least 6 months post-conversion was compared to LVM pre-conversion. In a secondary analysis, we examined echocardiograms performed at least 12 months after starting INHD. The effect of conversion to INHD on LVM over time was also evaluated using a longitudinal analysis that incorporated all LVM data on patients with 2 or more echocardiograms.
  
  
  RESULTS
  Thirty-seven patients were eligible for the primary analysis. Mean age at conversion was 49 ± 12 yrs and 30% were women. Mean pre-conversion LVM was 219 ± 66 g and following conversion, LVM declined by 32 ± 58 g (p = 0.002). Among patients whose follow-up echocardiogram occurred at least 12 months following conversion, LVM declined by 40 ± 56 g (p = 0.0004). The rate of change of LVM decreased significantly from 0.4 g/yr before conversion, to -11.7 g/yr following conversion to INHD (p < 0.0001).
  
  
  CONCLUSIONS
  Conversion to INHD is associated with a significant regression in LVM, which may portend a more favourable cardiovascular outcome. Our preliminary findings support the need for randomized controlled trials to definitively evaluate the cardiovascular effects of INHD.
authors.affiliation: Division of Nephrology, St. Michael's Hospital and Univerity of Toronto, Toronto, Ontario, Canada. waldr@smh.ca
authors.forename: Ron
authors.initials: R
authors.lastname: Wald
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perl
authors.forename: Depeng
authors.initials: D
authors.lastname: Jiang
authors.forename: M Sandra
authors.initials: MS
authors.lastname: Donnelly
authors.forename: Howard
authors.initials: H
authors.lastname: Leong-Poi
authors.forename: Philip A
authors.initials: PA
authors.lastname: McFarlane
authors.forename: Jordan J
authors.initials: JJ
authors.lastname: Weinstein
authors.forename: Marc B
authors.initials: MB
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D002940:Circadian Rhythm / Q000502:physiology; D018592:Cross-Over Studies; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006437:Hemodialysis, Home / Q000009:adverse effects / Q000379:methods; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014463:Ultrasonography