title: Effects of frequent hemodialysis on ventricular volumes and left ventricular remodeling.
abstract: OBJECTIVE
  Higher left ventricular volume is associated with death in patients with ESRD. This work investigated the effects of frequent hemodialysis on ventricular volumes and left ventricular remodeling.
  
  
  METHODS
  The Frequent Hemodialysis Network daily trial randomized 245 patients to 12 months of six times per week versus three times per week in-center hemodialysis; the Frequent Hemodialysis Network nocturnal trial randomized 87 patients to 12 months of six times per week nocturnal hemodialysis versus three times per week predominantly home-based hemodialysis. Left and right ventricular end systolic and diastolic volumes, left ventricular mass, and ejection fraction at baseline and end of the study were ascertained by cardiac magnetic resonance imaging. The ratio of left ventricular mass/left ventricular end diastolic volume was used as a surrogate marker of left ventricular remodeling. In each trial, the effect of frequent dialysis on left or right ventricular end diastolic volume was tested between predefined subgroups.
  
  
  RESULTS
  In the daily trial, frequent hemodialysis resulted in significant reductions in left ventricular end diastolic volume (-11.0% [95% confidence interval, -16.1% to -5.5%]), left ventricular end systolic volume (-14.8% [-22.7% to -6.2%]), right ventricular end diastolic volume (-11.6% [-19.0% to -3.6%]), and a trend for right ventricular end systolic volume (-11.3% [-21.4% to 0.1%]) compared with conventional therapy. The magnitude of reduction in left and right ventricular end diastolic volumes with frequent hemodialysis was accentuated among patients with residual urine output<100 ml/d (P value [interaction]=0.02). In the nocturnal trial, there were no significant changes in left or right ventricular volumes. The frequent dialysis interventions had no substantial effect on the ratio of left ventricular mass/left ventricular end diastolic volume in either trial.
  
  
  CONCLUSIONS
  Frequent in-center hemodialysis reduces left and right ventricular end systolic and diastolic ventricular volumes as well as left ventricular mass, but it does not affect left ventricular remodeling.
authors: University Health Network, Toronto, Ontario, Canada;, †University of Utah, Salt Lake City, Utah;, ‡Stanford University, Stanford, California;, §Yale University School of Medicine, New Haven, Connecticut;, ‖University of Iowa, Iowa City, Iowa;, ¶Cleveland Clinic Foundation, Cleveland, Ohio;, *University of Illinois, Chicago, Illinois;, ††Renal Research Institute, New York, New York;, ‡‡University of California, San Diego, California;, §§Wake Forest University School of Medicine, Winston-Salem, North Carolina;, ‖‖Mount Sinai School of Medicine, New York, New York, ¶¶Ohio State University, Columbus, Ohio.
authors: Christopher T
authors: CT
authors: Chan
authors: Tom
authors: T
authors: Greene
authors: Glenn M
authors: GM
authors: Chertow
authors: Alan S
authors: AS
authors: Kliger
authors: John B
authors: JB
authors: Stokes
authors: Gerald J
authors: GJ
authors: Beck
authors: John T
authors: JT
authors: Daugirdas
authors: Peter
authors: P
authors: Kotanko
authors: Brett
authors: B
authors: Larive
authors: Nathan W
authors: NW
authors: Levin
authors: Ravindra L
authors: RL
authors: Mehta
authors: Michael
authors: M
authors: Rocco
authors: Javier
authors: J
authors: Sanz
authors: Phillip C
authors: PC
authors: Yang
authors: Sanjay
authors: S
authors: Rajagopalan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006437:Hemodialysis, Home; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D017380:Hypertrophy, Right Ventricular / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling
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