title: Effect of frequent or extended hemodialysis on cardiovascular parameters: a meta-analysis.
abstract: BACKGROUND
  Increased left ventricular (LV) mass is a risk factor for cardiovascular mortality in patients with chronic kidney failure. More frequent or extended hemodialysis (HD) has been hypothesized to have a beneficial effect on LV mass.
  
  
  METHODS
  Meta-analysis.
  
  
  METHODS
  MEDLINE literature search (inception to April 2011), Cochrane Central Register of Controlled Trials and ClinicalTrials.gov using the search terms "short daily HD," "daily HD," "quotidian HD," "frequent HD," "intensive HD," "nocturnal HD," and "home HD."
  
  
  METHODS
  Single-arm cohort studies (with pre- and post-study evaluations) and trials examining the effect of frequent or extended HD on cardiac morphology and function and blood pressure parameters. Studies of hemofiltration, hemodiafiltration, and peritoneal dialysis were excluded.
  
  
  METHODS
  Frequent (2-8 hours, >3 times weekly) or extended (>4 hours, 3 times weekly) HD compared with conventional (≤4 hours, 3 times weekly) HD.
  
  
  RESULTS
  Absolute changes in cardiac morphology and function, including LV mass index (LVMI; primary) and blood pressure parameters (secondary).
  
  
  RESULTS
  We identified 38 single-arm studies, 5 crossover trials, and 3 randomized controlled trials. By meta-analysis of 23 study arms, frequent or extended HD significantly reduced LVMI from baseline (-31.2 g/m(2), 95% CI, -39.8 to -22.5; P < 0.001). The 3 randomized trials found a less pronounced net reduction in LVMI (-7.0 g/m(2); 95% CI, -10.2 to -3.7; P < 0.001). LV ejection fraction improved by 6.7% (95% CI, 1.6% to 11.9%; P = 0.01). Other cardiac morphologic parameters showed similar improvements. There also were significant decreases in systolic, diastolic, and mean blood pressure and mean number of antihypertensive medications.
  
  
  CONCLUSIONS
  Paucity of randomized controlled trials.
  
  
  CONCLUSIONS
  Conversion from conventional to frequent or extended HD is associated with improvements in cardiac morphology and function, including LVMI and LV ejection fraction, respectively, and several blood pressure parameters, which collectively might confer long-term cardiovascular benefit. Trials with long-term clinical outcomes are needed.
authors.affiliation: Department of Medicine, Division of Nephrology, Kidney and Dialysis Research Laboratory, St. Elizabeth's Medical Center, Boston, MA 02135, USA.
authors.forename: Paweena
authors.initials: P
authors.lastname: Susantitaphong
authors.forename: Ioannis
authors.initials: I
authors.lastname: Koulouridis
authors.forename: Ethan M
authors.initials: EM
authors.lastname: Balk
authors.forename: Nicolaos E
authors.initials: NE
authors.lastname: Madias
authors.forename: Bertrand L
authors.initials: BL
authors.lastname: Jaber
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D006435:Renal Dialysis / Q000379:methods*; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome