Cardiac and vascular structure and function parameters do not improve with alternate nightly home hemodialysis: An interventional cohort study

van Eps, Carolyn L., Jeffriess, Leanne, Haluska, Brian, Hawley, Carmel M., Coombes, Jeffrey, Matsumoto, Aya, Janine K Jeffries, Johnson, David W., Campbell, Scott B., Isbel, Nicole M. and Mudge, David W. (2011) Cardiac and vascular structure and function parameters do not improve with alternate nightly home hemodialysis: An interventional cohort study. BMC Nephrology, 12 51: 1-15. doi:10.1186/1471-2369-12-51

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Author van Eps, Carolyn L.
Jeffriess, Leanne
Haluska, Brian
Hawley, Carmel M.
Coombes, Jeffrey
Matsumoto, Aya
Janine K Jeffries
Johnson, David W.
Campbell, Scott B.
Isbel, Nicole M.
Mudge, David W.
Title Cardiac and vascular structure and function parameters do not improve with alternate nightly home hemodialysis: An interventional cohort study
Journal name BMC Nephrology   Check publisher's open access policy
ISSN 1471-2369
Publication date 2011-10
Sub-type Article (original research)
DOI 10.1186/1471-2369-12-51
Open Access Status DOI
Volume 12
Issue 51
Start page 1
End page 15
Total pages 15
Place of publication London, England, U.K.
Publisher BioMed Central
Collection year 2012
Language eng
Formatted abstract

Nightly extended hours hemodialysis may improve left ventricular hypertrophy and function and endothelial function but presents problems of sustainability and increased cost. The effect of alternate nightly home hemodialysis (NHD) on cardiovascular structure and function is not known.


Sixty-three patients on standard hemodialysis (SHD: 3.5-6 hours/session, 3-5 sessions weekly) converted to NHD (6-10 hours/session overnight for 3-5 sessions weekly). 2Dimensional transthoracic echocardiography and ultrasound measures of brachial artery reactivity (BAR), carotid intima-media thickness (CIMT), total arterial compliance (TAC) and augmentation index (AIX) were performed post dialysis at baseline and 18-24 months following conversion to NHD. In 37 patients, indices of oxidative stress: plasma malonyldialdehyde (MDA) and anti-oxidant enzymes: catalase (CAT), glutathione peroxidase (GPX) and superoxide dismutase (SOD) activity and total antioxidant status (TAS) were measured at baseline, 3 and 6 months.


Left ventricular mass index (LVMI) remained stable. Despite significant derangement at baseline, there were no changes in diastolic function measures, CIMT, BAR and TAC. AIX increased. Conversion to NHD improved bone mineral metabolism parameters and blood pressure control. Interdialytic weight gains increased. No definite improvements in measures of oxidative stress were demonstrated.


Despite improvement in uremic toxin levels and some cardiovascular risk factors, conversion to an alternate nightly NHD regimen did not improve cardiovascular structure and function. Continuing suboptimal control of uremic toxins and interdialytic weight gains may be a possible explanation. This study adds to the increasing uncertainty about the nature of improvement in cardiovascular parameters with conversion to intensive hemodialysis regimens. Future randomized controlled trials will be important to determine whether increases in dialysis session duration, frequency or both are most beneficial for improving cardiovascular disease whilst minimizing costs and the impact of dialysis on quality of life.
Keyword Diastolic function
Ejection fraction
Left ventricular mass index
Left ventricular hypertrophy
Nocturnal hemodialysis
Carotid intima-media thickness
Oxidative stress
Arterial compliance
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Human Movement and Nutrition Sciences Publications
School of Medicine Publications
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Created: Fri, 28 Oct 2011, 12:35:12 EST by Matthew Lamb on behalf of School of Medicine