Journal article
Predictors of change in left-ventricular structure and function in a trial of extended hours hemodialysis
Journal of Cardiac Failure, Vol.26(6), pp.482-491
2020
Abstract
Background: Myocardial pathology is common in hemodialysis patients. To explore the effects of different aspects of dialysis treatment on its evolution, we examined the impact of change in markers of volume status, hemodynamics and solute clearance on left ventricular (LV) parameters in a randomized trial of extended dialysis hours. Methods: ACTIVE Dialysis randomized 200 hemodialysis patients to extended dialysis hours (≥24 hours/week) or standard hours (12-18 hours/week) for 12 months. In a pre-specified substudy, 95 participants underwent cardiac magnetic resonance imaging (CMR) at baseline and study end. Generalized linear regression was used to model the relationship between changes LV parameters and markers of volume status (normalized ultrafiltration [UF] rate and total weekly interdialytic weight gain [IDWG]), hemodynamic changes (systolic and diastolic blood pressure [BP]) and solute control (Kt/V, dialysis hours and phosphate). Results: Randomization to extended hours dialysis was not associated with change in any CMR parameter. Reduction in UF rate was associated with reduction in LV mass index (LVMI) (P=0.049) and improved ejection fraction (EF) (P=0.024); reduction in systolic BP was also associated with improvement in EF (P=0.045); reduction in IDWG was associated with reduced stroke volume (SV) (P=0.038). There were no associations between change in Kt/V, phosphate or total hours per week, and CMR parameters. Conclusions: Reduction in ultrafiltration rate and blood pressure are associated with improved myocardial parameters in hemodialysis recipients independently of solute clearance or dialysis time. These findings underscore the importance of fluid status and related parameters as potential treatment targets in this population.
Details
- Title
- Predictors of change in left-ventricular structure and function in a trial of extended hours hemodialysis
- Authors
- Brendan Smyth (Author)Christopher T Chan (Author)Stuart M Grieve (Author)Rajesh Puranik (Author)Li Zuo (Author)Daqing Hong (Author)Nicholas A Gray (Author) - University of the Sunshine Coast - School of Health and Sport SciencesJanak R de Zoysa (Author)Anish Scaria (Author)Martin Gallagher (Author)Vlado Perkovic (Author)Meg Jardine (Author)
- Publication details
- Journal of Cardiac Failure, Vol.26(6), pp.482-491
- Publisher
- Elsevier Inc.
- Date published
- 2020
- DOI
- 10.1016/j.cardfail.2020.03.010
- ISSN
- 1071-9164
- Copyright note
- Copyright © 2020. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
- Organisation Unit
- UniSC Clinical Trials Centre; University of the Sunshine Coast, Queensland; School of Health and Sport Sciences - Legacy; School of Health and Behavioural Sciences - Legacy
- Language
- English
- Record Identifier
- 99450973102621
- Output Type
- Journal article
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- Cardiac & Cardiovascular Systems
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