Document Detail

Determinants of left ventricular mass in patients on hemodialysis: Frequent Hemodialysis Network (FHN) Trials.
MedLine Citation:
PMID:  22360996     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: An increase in left ventricular mass (LVM) is associated with mortality and cardiovascular morbidity in patients with end-stage renal disease.
METHODS AND RESULTS: The Frequent Hemodialysis Network (FHN) Daily Trial randomized 245 patients to 12 months of 6 times per week daily in-center hemodialysis or conventional hemodialysis; the FHN Nocturnal Trial randomized 87 patients to 12 months of 6 times per week nocturnal hemodialysis or conventional hemodialysis. The main cardiac secondary outcome was change in LVM. In each trial, we examined whether several predefined baseline demographic or clinical factors as well as change in volume removal, blood pressure, or solute clearance influenced the effect of frequent hemodialysis on LVM. In the Daily Trial, frequent hemodialysis resulted in a significant reduction in LVM (13.1 g; 95% CI, 5.0-21.3 g; P=0.002), LVM index (6.9 g/m(2); 95% CI, 2.4-11.3 g/m(2); P=0.003), and percent change in geometric mean of LVM (7.0%; 95% CI, 1.0%-12.6; P=0.02). Similar trends were noted in the Nocturnal Trial but did not reach statistical significance. In the Daily Trial, a more pronounced effect of frequent hemodialysis on LVM was evident among patients with left ventricular hypertrophy at baseline. Changes in LVM were associated with changes in blood pressure (conventional hemodialysis: R=0.28, P=0.01, daily hemodialysis: R=0.54, P<0.001) and were not significantly associated with changes in other parameters.
CONCLUSIONS: Frequent in-center hemodialysis reduces LVM. The benefit of frequent hemodialysis on LVM may be mediated by salutary effects on blood pressure. Clinical Trial Registration- URL: Unique identifier: NCT00264758.
Christopher T Chan; Tom Greene; Glenn M Chertow; Alan S Kliger; John B Stokes; Gerald J Beck; John T Daugirdas; Peter Kotanko; Brett Larive; Nathan W Levin; Ravindra L Mehta; Michael Rocco; Javier Sanz; Brigitte M Schiller; Phillip C Yang; Sanjay Rajagopalan;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2012-02-23
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  5     ISSN:  1942-0080     ISO Abbreviation:  Circ Cardiovasc Imaging     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-03-22     Completed Date:  2012-05-10     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  251-61     Citation Subset:  IM    
University Health Network, Ontario, Canada.
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MeSH Terms
Blood Pressure
Hypertrophy, Left Ventricular / diagnosis,  etiology*,  mortality,  physiopathology
Kidney Failure, Chronic / complications,  mortality,  physiopathology,  therapy*
Linear Models
Magnetic Resonance Imaging
Middle Aged
Proportional Hazards Models
Prospective Studies
Renal Dialysis / adverse effects,  methods*,  mortality
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
Grant Support
R01 DK091288-01/DK/NIDDK NIH HHS; R01 DK091288-02/DK/NIDDK NIH HHS

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