Document Detail


Frequent hemodialysis schedules are associated with reduced levels of dialysis-induced cardiac injury (myocardial stunning).
MedLine Citation:
PMID:  21597028     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: Recurrent hemodialysis (HD)-induced ischemic cardiac injury (myocardial stunning) is common and associated with high ultrafiltration (UF) requirements, intradialytic hypotension, long-term loss of systolic function, increased likelihood of cardiovascular events, and death. More frequent HD regimens are associated with lower UF requirements and improved hemodynamic tolerability, improved cardiovascular outcomes, and reduced mortality compared with conventional thrice-weekly HD. This study investigated the hypothesis that modification of UF volume and rate with more frequent HD therapies would abrogate dialysis-induced myocardial stunning.
DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS: A cross-sectional study of 46 patients established on hemodialysis >3 months compared four groups receiving the current range of quotidian therapies: conventional thrice-weekly HD (CHD3); more-frequent HD five to six times/week in a center (CSD) and at home (HSD); and home nocturnal HD (HN). Serial echocardiography quantitatively assessed regional systolic function to identify intradialytic left ventricular regional wall motion abnormalities (RWMAs). Cardiac troponin T (cTnT), N-terminal prohormone brain natriuretic peptide (NT-proBNP), and inflammatory markers were quantified.
RESULTS: More frequent HD regimens were associated with lower UF volumes and rates compared with CHD3. Intradialytic fall in systolic BP was reduced in CSD and HSD groups and abolished in HN group. Mean RWMAs per patient reduced with increasing dialysis intensity (CHD3 > CSD > HSD > HN). Home-based groups demonstrated lower high-sensitivity C-reative protein levels, with trends to lower cTnT and NT-proBNP levels in the more frequent groups.
CONCLUSIONS: Frequent HD regimes are associated with less dialysis-induced myocardial stunning compared with conventional HD. This may contribute to improved outcomes associated with frequent HD therapies.
Authors:
Helen J Jefferies; Bhupinder Virk; Brigitte Schiller; John Moran; Christopher W McIntyre
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2011-05-19
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  6     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-09     Completed Date:  2011-09-30     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1326-32     Citation Subset:  IM    
Affiliation:
Department of Renal Medicine, Royal Derby Hospital, Derby, UK.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Biological Markers / blood
Blood Pressure
C-Reactive Protein / metabolism
California
Cross-Sectional Studies
Female
Humans
Inflammation Mediators / blood
Male
Middle Aged
Myocardial Stunning / blood,  etiology,  physiopathology,  prevention & control*,  ultrasonography
Natriuretic Peptide, Brain / blood
Peptide Fragments / blood
Renal Dialysis / adverse effects,  methods*
Time Factors
Treatment Outcome
Troponin T / blood
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Inflammation Mediators; 0/Peptide Fragments; 0/Troponin T; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 9007-41-4/C-Reactive Protein
Comments/Corrections
Comment In:
Semin Dial. 2012 Jan-Feb;25(1):86-7   [PMID:  22273531 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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