Abstract
Background
In-centre nocturnal hemodialysis (INHD, 7-8 hours/session, 3 times/week) is an increasingly
utilized form of dialysis intensification, though data on the cardiovascular benefits
of this modality are limited.
Methods
In this prospective cohort study, we enrolled 67 prevalent conventional hemodialysis
(CHD, 4 hours/session, 3 times/week) recipients at 2 medical centres in Canada, of
whom 37 converted to INHD and 30 remained on CHD. The primary outcome was the change
in left ventricular mass (LVM) after 1 year as assessed by cardiac magnetic resonance
imaging. Secondary outcomes included changes in serum phosphate concentration, phosphate
binder burden, haemoglobin, erythropoiesis stimulating agent usage, and blood pressure.
Results
Conversion to INHD was associated with a 14.2 (95% confidence interval [CI] 1.2-27.2)
g reduction in LVM as compared with continuation on CHD. This result was maintained
after adjustment for baseline imbalances between the groups and in ancillary analyses.
There was a trend toward a larger drop in systolic blood pressure (9.8 [95% CI, −1.4-20.9]
mm Hg) among INHD recipients with a significant reduction in the number of prescribed
antihypertensive agents (0.7 [95% CI, 0.3-1.1] agents). Serum phosphate declined by
0.40 (95% CI, 0.16-0.63) mmol/L among INHD recipients without any difference in calcium-based
phosphate binder requirements, as compared with those who remained on CHD.
Conclusions
Compared with continuation of CHD, conversion to INHD was associated with significant
LVM regression and reduction in serum phosphate concentration at 1 year.
Résumé
Introduction
L’hémodialyse nocturne en centre (HDNC), qui consiste en des séances de 7 à 8 heures
3 fois par semaine, est une méthode de plus en plus utilisée pour intensifier la dialyse;
or, les données relatives à ses bienfaits sur la santé cardiovasculaire demeurent
encore limitées.
Méthodes
Dans le cadre de cette étude de cohorte prospective, 67 patients traités par hémodialyse
traditionnelle (HDT) (séances de 4 heures, 3 fois par semaine) dans 2 centres médicaux
canadiens ont été admis. De ces patients, 37 sont passés à l’HDNC, tandis que les
30 autres ont poursuivi l’HDT. Le critère d’évaluation principal était la variation
de la masse ventriculaire gauche après 1 an, évaluée par résonance magnétique cardiaque.
Les critères d’évaluation secondaires comprenaient la variation de la concentration
de phosphore sérique, le fardeau associé à la prise de chélateurs de phosphore, le
taux d’hémoglobine, l’emploi d’agents stimulant l’érythropoïèse et la pression artérielle.
Résultats
Le passage à l’HDNC a donné lieu une réduction de la masse ventriculaire gauche de
14,2 g (intervalle de confiance [IC] à 95 %, 1,2-27,2) par rapport à la poursuite
de l’HDT. Ce résultat est demeuré le même après les ajustements apportés aux données
initiales des patients afin d’équilibrer les groupes et les analyses additionnelles.
Les patients traités par HDNC ont obtenu une plus importante réduction de leur pression
artérielle systolique (9,8 mm Hg [IC à 95 %, -1,4-20,9]), ce qui a entraîné une diminution
significative des ordonnances d’antihypertenseurs (0,7 agent [IC à 95 %, 0,3-1,1]).
Toujours chez les patients traités par HDNC, le taux de phosphore sérique a diminué
de 0,40 mmol/l (IC à 95 %, 0,16-0,63), mais aucune différence n’a été relevée en ce
qui a trait aux besoins en chélateurs de phosphore à base de calcium par rapport aux
patients qui avaient poursuivi le traitement par l’HDT.
Conclusion
Comparativement aux patients qui avaient poursuivi le traitement par l’HDT, les patients
qui étaient passés à l’HDNC ont présenté une régression significative de leur masse
ventriculaire gauche et une diminution de leur taux de phosphore sérique après 1 an.
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Article info
Publication history
Published online: July 09, 2015
Accepted:
July 5,
2015
Received:
May 16,
2015
Footnotes
See page 376 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
