title: Intensive Hemodialysis, Left Ventricular Hypertrophy, and Cardiovascular Disease.
abstract: The prevalence of cardiovascular disease, including cardiac arrhythmia, coronary artery disease, cardiomyopathy, and valvular heart disease, is higher in hemodialysis (HD) patients than in the US resident population. Cardiovascular disease is the leading cause of death in HD patients and the principal discharge diagnosis accompanying 1 in 4 hospital admissions. Furthermore, the rate of hospital admissions for either heart failure or fluid overload is persistently high despite widespread use of β-blockers and renin-angiotensin system inhibitors and attempts to manage fluid overload with ultrafiltration. An important predictor of cardiovascular mortality and morbidity in dialysis patients is left ventricular hypertrophy (LVH). LVH is an adaptive response to increased cardiac work, typically caused by combined pressure and volume overload, resulting in cardiomyocyte hypertrophy and increased intercellular matrix. In new dialysis patients, the prevalence of LVH is 75%. Regression of LVH may reduce cardiovascular risk, including the incidence of heart failure, complications after myocardial infarction, and sudden arrhythmic death. Multiple randomized clinical trials show that intensive HD reduces left ventricular mass, a measure of LVH. Short daily and nocturnal schedules in the Frequent Hemodialysis Network trial reduced left ventricular mass by 14 (10%) and 11 (8%) g, respectively, relative to 3 sessions per week. Comparable efficacy was observed in an earlier trial of nocturnal HD. Intensive HD also improves cardiac rhythm. Clinical benefits have been reported only in observational studies. Daily home HD is associated with 17% and 16% lower risks for cardiovascular death and hospitalization, respectively; admissions for cerebrovascular disease, heart failure, and hypertensive disease, which collectively constitute around half of cardiovascular hospitalizations, were less likely with daily home HD. Relative to peritoneal dialysis, daily home HD is likewise associated with lower risk for cardiovascular hospitalization. In conclusion, intensive HD likely reduces left ventricular mass and may lead to lower risks for adverse cardiac events.
authors: Baylor University Medical Center, Dallas, TX; Baylor Heart and Vascular Institute, Dallas, TX; Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX; The Heart Hospital Baylor Plano, Plano, TX.
authors: Peter A
authors: PA
authors: McCullough
authors: Division of Nephrology, Department of Medicine, University Health Network, Toronto, Canada.
authors: Christopher T
authors: CT
authors: Chan
authors: Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN. Electronic address: wein0205@umn.edu.
authors: Eric D
authors: ED
authors: Weinhandl
authors: Wake Forest University Medical Center, Winston-Salem, NC.
authors: John M
authors: JM
authors: Burkart
authors: American Society of Hypertension Comprehensive Hypertension Center, Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Chicago Medicine, Chicago, IL.
authors: George L
authors: GL
authors: Bakris
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D006435:Renal Dialysis / Q000379:methods
keywords: Cardiac arrhythmia; Frequent Hemodialysis Network; cardiovascular disease; chronic kidney disease; daily dialysis; end-stage renal disease; fluid overload; heart failure; heart rhythm; home dialysis; intensive hemodialysis; nocturnal hemodialysis; review; short daily hemodialysis