Predictors of Change in Left-Ventricular Structure and Function in a Trial of Extended Hours Hemodialysis
Section snippets
ACTIVE Dialysis MRI Substudy
The design and primary results of the ACTIVE Dialysis trial have been reported previously.9,10 Briefly, 200 patients undergoing hemodialysis, who were from 40 sites in China, Australia, New Zealand, and Canada, were randomized to 12 months of standard hours of dialysis (≤ 18 hours per week) or to extended hours of dialysis (≥ 24 hours per week). A minimum of 3 dialysis sessions per week was specified for both groups. Participants from 29 sites with access to CMR and no contraindication to this
Baseline characteristics and effect of randomized allocation
In the ACTIVE Dialysis study, 200 participants were enrolled, of whom 95 (51 extended hours, 44 standard hours) were included in the CMR substudy. At baseline, the substudy population was similar to the broader study cohort, and they experienced similar changes in dialysis schedules. Within the substudy, baseline characteristics were balanced between groups (Table 2), and participants in the extended hours dialysis group increased their total weekly dialysis time by a median of 12 hours (IQR
Discussion
In this exploratory analysis of participants in the ACTIVE Dialysis study, favorable changes in 2 myocardial parameters (LVMI and EF) were associated with reduction in the rate of ultrafiltration. Reduction in systolic blood pressure was associated with improvement in EF. These associations were independent of changes in dialysis time or Kt/V or phosphate levels. Collectively, these findings are consistent with a central role for volume overload and related stresses in the myocardial pathology
Conclusion
In conclusion, changes in volume status and hemodynamics (such as the rate of UF) may be more influential on myocardial pathology in hemodialysis recipients than solute clearance and dialysis time alone. Future studies should consider whether interventions specifically targeting these parameters can influence cardiac and clinical outcomes.
Authors’ contributions
Research inception, study design and leadership: MJ; Critical review of study design and oversight of study conduct: VP, MG, AC; Analysis plan: CC, BS, MJ, DH, LZ; Data acquisition: SMG, RP; Statistical analysis: AS, BS; Participant recruitment: MJ, LZ, NAG, JRdZ, CC; Manuscript preparation: BS; Drafting and revision of manuscript: VP, SMG, MG, NAG, RP, JRdZ, MJ, DH, CC. Each author contributed important intellectual content during manuscript drafting or revision, and has approved the final
Support
The ACTIVE Dialysis study was funded by National Health and Medical Research Council of Australia grants APP571045 and APP358395 and by an unrestricted grant from Baxter International. The funders had no role in the study's design, collection, analysis and interpretation of data, writing of the report, or the decision to submit it for publication. BS is supported by an Australian Government Research Training Program Scholarship via the University of Sydney. MJ is supported by a Medical Research
Financial disclosures
BS reports receiving travel support from Roche and Vimedimex Binh Duong; he serves as Associate Editor for Kidney Blood Pressure Research. CC reports receiving consulting fees and grant support from Medtronic. MG reports speaking fees from Astra-Zeneca. MJ reports consulting or serving on advisory board for Akebia, Baxter, and Vifor, she has received speaking fees from Vifor and Janssen and has received grant support from Merck Sharpe & Dohme and Eli Lilly, with all honoraria paid to her
Acknowledgments
Thank you to Dr. Rathika Krishnasamy for her critical review of the manuscript.
References (32)
- et al.
Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality
Kidney Int
(2011) - et al.
Limited reduction in uremic solute concentrations with increased dialysis frequency and time in the Frequent Hemodialysis Network Daily Trial
Kidney Int
(2017) - et al.
The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial
Kidney Int
(2011) - et al.
Serum phosphorus is related to left ventricular remodeling independent of renal function in hospitalized patients with chronic kidney disease
Int J Cardiol
(2016) - et al.
Relationships between left ventricular structure and function according to cardiac mri and cardiac biomarkers in end-stage renal disease
Can J Cardiol
(2017) - et al.
Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on left ventricular mass index and ejection fraction in hemodialysis patients: a meta-analysis with trial sequential analysis of randomized controlled trials
Int J Cardiol
(2016) - et al.
Cardiovascular magnetic resonance left ventricular strain in end-stage renal disease patients after kidney transplantation
J Cardiovasc Magn Reson
(2018) - et al.
Left ventricular structural remodeling in health and disease: with special emphasis on volume, mass, and geometry
J Am Coll Cardiol
(2011) - et al.
The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) study
J Am Coll Cardiol
(2008) - et al.
Intensive home hemodialysis results in regression of left ventricular hypertrophy and better clinical outcomes
Am J Nephrol
(2016)
Association between clinical and doppler echocardiographic parameters with sudden death in hemodialysis patients
Arq Bras Cardiol
Left ventricular mass in chronic kidney disease and ESRD
Clin J Am Soc Nephrol
Induction of cardiac FGF23/FGFR4 expression is associated with left ventricular hypertrophy in patients with chronic kidney disease
Nephrol Dial Transplant
Klotho protects against indoxyl sulphate-induced myocardial hypertrophy
J Am Soc Nephrol
Effects of frequent hemodialysis on ventricular volumes and left ventricular remodeling
Clin J Am Soc Nephrol
Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life: a randomized controlled trial
JAMA
Cited by (0)
See page 490 for disclosure information.