Cardiovascular Benefits of Extended-Time Nocturnal Hemodialysis

Hemodialysis (HD) remains the most utilized treatment for End-Stage Kidney Disease (ESKD) globally, mainly as conventional HD administered in 4 h sessions thrice weekly. Despite advances in HD delivery, patients with ESKD carry a heavy cardiovascular morbidity and mortality burden. This is associated with cardiac remodeling, left ventricular hypertrophy (LVH), myocardial stunning, hypertension, decreased heart rate variability, sleep apnea, coronary calcification and endothelial dysfunction. Therefore, intensive HD regimens closer to renal physiology were developed. They include longer, more frequent dialysis or both. Among them, Nocturnal Hemodialysis (NHD), carried out at night while asleep, provides efficient dialysis without excessive interference with daily activities. This regimen is closer to the physiology of the native kidneys. By providing increased clearance of small and middle molecular weight molecules, NHD can ameliorate uremic symptoms, control hyperphosphatemia and improve quality of life by allowing a liberal diet and free time during the day. Lastly, it improves reproductive biology leading to successful pregnancies. Conversion from conventional to NHD is followed by improved blood pressure control with fewer medications, regression of LVH, improved LV function, improved sleep apnea, and stabilization of coronary calcifications. These beneficial effects have been associated, among others, with better extracellular fluid volume control, improved endothelial- dependent vasodilation, decreased total peripheral resistance, decreased plasma norepinephrine levels and restoration of heart rate variability. Some of these effects represent improvements in outcomes used as surrogates of hard outcomes related to cardiovascular morbidity and mortality. In this review, we consider the cardiovascular effects of NHD.

Download Full-text

Short-term secondhand smoke exposure decreases heart rate variability and increases arrhythmia susceptibility in mice

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.91535.2007 ◽

2008 ◽

Vol 295 (2) ◽

pp. H632-H639 ◽

Cited By ~ 34

Author(s):

Chao-Yin Chen ◽

Drin Chow ◽

Nipavan Chiamvimonvat ◽

Kathryn A. Glatter ◽

Ning Li ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Secondhand Smoke ◽

Suspended Particle ◽

Air Pollutant ◽

Cardiovascular Morbidity ◽

Morbidity And Mortality ◽

Short Term ◽

Cardiovascular Morbidity And Mortality ◽

Shs Exposure

Exposure to secondhand smoke (SHS), a major indoor air pollutant, is linked to increased cardiovascular morbidity and mortality, including cardiac arrhythmias. However, the mechanisms underlying the epidemiological findings are not well understood. Impaired cardiac autonomic function, indexed by reduced heart rate variability (HRV), may represent an underlying cause. The present study takes advantage of well-defined short-term SHS exposure (3 days, 6 h/day) on HRV and the susceptibility to arrhythmia in mice. With the use of electrocardiograph telemetry recordings in conscious mice, HRV parameters in the time domain were measured during the night after each day of exposure and 24 h after 3 days of exposure to either SHS or filtered air. The susceptibility to arrhythmia was determined after 3 days of exposure. Exposure to a low concentration of SHS [total suspended particle (TSP), 2.4 ± 3.2; and nicotine, 0.3 ± 0.1 mg/m3] had no significant effect on HRV parameters. In contrast, the exposure to a higher but still environmentally relevant concentration of SHS (TSP, 30 ± 1; and nicotine, 5 ± 1 mg/m3) significantly reduced HRV starting after the first day of exposure and continuing 24 h after the last day of exposure. Moreover, the exposed mice showed a significant increase in ventricular arrhythmia susceptibility and atrioventricular block. The data suggest that SHS exposure decreased HRV beyond the exposure period and was associated with an increase in arrhythmia susceptibility. The data provide insights into possible mechanisms underlying documented increases in cardiovascular morbidity and mortality in humans exposed to SHS.

Download Full-text

Abstract 2113: Early End-organ Alterations Due To High Blood Pressure In Children

Circulation ◽

10.1161/circ.116.suppl_16.ii_458-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Reinhard G Ketelhut ◽

Ulrich Rode ◽

Jörg Schröter

Keyword(s):

Blood Pressure ◽

Diastolic Function ◽

High Blood Pressure ◽

Diastolic Pressure ◽

Left Ventricular ◽

Cardiovascular Morbidity ◽

Morbidity And Mortality ◽

Lv Function ◽

Cardiovascular Morbidity And Mortality ◽

Lv Mass

Introduction : Increased left ventricular (LV) mass is known to be an important risk for future cardiovascular morbidity and mortality. Since high blood pressure can be observed more often in early childhood a study was designed to evaluate the influence of blood pressure (BP) on LV mass and function in children. Methods: 2-D-guided-echocardiography and Doppler-echocardiography were performed in 103 children (aged 14.1±0.9 years, 58 girls). BP, LV-mass-index (LVMI) and diastolic function (E/A ratio) were measured and calculated by standardized formula and procedure. Results: Systolic BP (SBP) was significantly higher in boys (124.8±10.6 mmHg) when compared with girls (120.5±8.4 mmHg) (p<0.01). There were no significant differences in diastolic pressure. LVMI was significantly lower in girls (57.6±8.9 g/m 2 ) than in boys (68.3±11.2 g/m 2 ) (p<0.01). There was a negative correlation between SBP and E/A ratio as a measure of LV diastolic function (p<0.01). Hypertensives had a 17% higher LVMI (78±11g/m 2 versus 67±11g/m 2 ; p<0.05), and a 20% lower E/A ratio (1.58±0.3 versus 1.97±0.42) than their normotensive counterparts (p<0.01). Conclusion: Despite the young age of participants with higher blood pressure they had prognostically adverse preclinical cardiovascular disease, including LV hypertrophy and evidence of impaired LV function. Therefore children should be encouraged to enter preventive programs as a primary and early strategy against future cardiovascular morbidity and mortality.

Download Full-text

Cardiovascular morbidity and mortality in patients treated with hemodialysis: Epidemiological analysis

Vojnosanitetski pregled ◽

10.2298/vsp0812893p ◽

2008 ◽

Vol 65 (12) ◽

pp. 893-900 ◽

Cited By ~ 6

Author(s):

Dejan Petrovic ◽

Biljana Stojimirovic

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Mortality Rate ◽

Cardiovascular Mortality ◽

Cardiovascular Complications ◽

Left Ventricular ◽

Cardiovascular Morbidity ◽

Morbidity And Mortality ◽

Cardiovascular Morbidity And Mortality ◽

Lv Mass

Background/Aim. Cardiovascular diseases are the leading cause of death in patients treated with hemodialysis (HD). The annual cardiovascular mortality rate in these patients is 9%. Left ventricular (LV) hypertrophy, ischemic heart disease and heart failure are the most prevalent cardiovascular causes of death. The aim of this study was to assess the prevalence of traditional and nontraditional risk factors for cardiovascular complications, to assess the prevalence of cardiovascular complications and overall and cardiovascular mortality rate in patients on HD. Methods. We investigated a total of 115 patients undergoing HD for at least 6 months. First, a cross-sectional study was performed, followed by a two-year follow-up study. Beside standard biochemical parameters, we also determined cardiac troponins and echocardiographic parameters of LV morphology and function (LV mass index, LV fractional shortening, LV ejection fraction). The results were analyzed using the Student's t test and Mann-Whitney U test. Results. The patients with adverse outcome had significantly lower serum albumin (p < 0.01) and higher serum homocystein, troponin I and T, and LV mass index (p < 0.01). Hyperhomocysteinemia, anemia, hypertriglyceridemia and uncontrolled hypertension had the highest prevalence (86.09%, 76.52%, 43.48% and 36.52%, respectively) among all investigated cardiovascular risk factors. Hypertrophy of the LV was presented in 71.31% of the patients and congestive heart failure in 8.70%. Heart valve calcification was found in 48.70% of the patients, pericardial effusion in 25.22% and disrrhythmia in 20.87% of the investigated patients. The average annual overall mortality rate was 13.74%, while average cardiovascular mortality rate was 8.51%. Conclusion. Patients on HD have high risk for cardiovascular morbidity and mortality.

Download Full-text

Left ventricular hypertrophy in patients treated with regular hemodialyses

Medicinski pregled ◽

10.2298/mpns0808369p ◽

2008 ◽

Vol 61 (7-8) ◽

pp. 369-374 ◽

Cited By ~ 6

Author(s):

Dejan Petrovic ◽

Biljana Stojimirovic

Keyword(s):

Risk Factors ◽

Left Ventricle ◽

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Pressure Overload ◽

Left Ventricular ◽

Cardiovascular Morbidity ◽

Morbidity And Mortality ◽

Concentric Hypertrophy ◽

Cardiovascular Morbidity And Mortality

Left ventricular hypertrophy is the main risk factor for development of cardiovascular morbidity and mortality in patients on hemodialysis. Left ventricular hypertrophy is found in 75% of the patients treated with hemodialysis. Risk factors for left ventricular hypertrophy in patients on hemodialysis include: blood flow through arterial-venous fistula, anemia, hypertension, increased extracellular fluid volume, oxidative stress, microinflammation, hyperhomocysteinemia, secondary hyperpara- thyroidism, and disturbed calcium and phosphate homeostasis. Left ventricular pressure overload leads to parallel placement of new sarcomeres and development of concentric hypertrophy of left ventricle. Left ventricular hypertrophy advances in two stages. In the stage of adaptation, left ventricular hypertrophy occurs as a response to increased tension stress of the left ventricular wall and its action is protective. When volume and pressure overload the left ventricle chronically and without control, adaptive hypertrophy becomes maladaptive hypertrophy of the left ventricle, where myocytes are lost, systolic function is deranged and heart insufficiency is developed. Left ventricular mass index-LVMi greater than 131 g/m2 in men and greater than 100 g/m2 in women, and relative wall thickness of the left ventricle above 0.45 indicate concentric hypertrophy of the left ventricle. Eccentric hypertrophy of the left ventricle is defined echocardiographically as LVMi above 131 g/m2 in men and greater than 100 g/m2 in women, with RWT ?0.45. Identification of patients with increased risk for development of left ventricular hypertrophy and application of appropriate therapy to attain target values of risk factors lead to regression of left ventricular hypertrophy, reduced cardiovascular morbidity and mortality rates and improved quality of life in patients treated with regular hemodialyses.

Download Full-text