Original ArticlesDialysis

Frequent Hemodialysis Schedules Are Associated with Reduced Levels of Dialysis-induced Cardiac Injury (Myocardial Stunning)

Helen J. Jefferies, Bhupinder Virk, Brigitte Schiller, John Moran and Christopher W. McIntyre
CJASN June 2011, 6 (6) 1326-1332; DOI: https://doi.org/10.2215/CJN.05200610

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Ultrafiltration characteristics and regional wall motion abnormalities. (A) Mean ± SD UF volume, by dialysis modality. CHD3 versus CSD, P = 0.003; CHD3 versus HSD, HN, P < 0.001; CSD versus HN, P = 0.001. (B) Mean ± SD UF rate, by dialysis modality. CHD3 versus HSD, HN, P < 0.001; CSD versus HN, P < 0.001; HSD versus HN, P = 0.043. (C) Mean ± SD number of peak stress RWMAs, by dialysis modality. CHD3 versus HSD, P = 0.008; CHD3 versus HN, P = 0.019; CSD versus HN, P = 0.037. (D) Correlation between number of peak stress RWMAs and UF rate. r = 0.41, P = 0.005.

  • Figure 2.
    Figure 2.

    Change in systolic BP (predialysis to peak stress).

  • Figure 3.
    Figure 3.

    Markers of inflammation, cardiac damage, and congestion, by group. (A) Predialysis hsCRP levels by group. CSD versus HN, P = 0.018. (B) Predialysis cardiac troponin T levels by group. (C) Predialysis NT-proBNP levels by group.

Tables

  • Table 1.

    Patient characteristics

    CHD3CSDHSDHN
    Demographics
        male gender (%)42507580
        age (years)52 ± 1455 ± 1647 ± 1557 ± 10
        vintage (years)4.7 ± 3.95.6 ± 5.25.4 ± 6.810.7 ± 9.6
        diabetes (%)58581710
        IHD (%)833820
        mean resting ejection fraction (%)30–4030–4030–4030–40
    Plasma measures
        pre-HD Na+ (mmol/L)136 ± 3136 ± 4138 ± 2137 ± 5
        post-HD Na+ (mmol/L)140 ± 3140 ± 5137 ± 2137 ± 2
        pre-HD K+(mmol/L)5.1 ± 0.65.2 ± 0.84.4 ± 0.54.2 ± 0.5
        post-HD K+(mmol/L)3.4 ± 0.54.2 ± 0.73.4 ± 0.43.3 ± 0.4
        pre-HD BUN (mmol/L)23.2 ± 5.218.1 ± 3.823.3 ± 7.120.3 ± 10.6
        post-HD BUN (mmol/L)6.6 ± 1.98.8 ± 2.013.6 ± 4.211.4 ± 7.3
        pre-HD Creat (μmol/L)888 ± 241619 ± 195936 ± 276738 ± 212
        post-HD Creat (μmol/L)330 ± 95298 ± 126535 ± 165421 ± 165
        pre-HD Ca2+ (mmol/L)2.25 ± 0.202.3 ± 0.132.31 ± 0.192.25 ± 0.17
        post-HD Ca2+ (mmol/L)2.34 ± 0.132.32 ± 0.162.39 ± 0.162.36 ± 0.09
        pre-HD Phos (mmol/L)1.9 ± 0.71.7 ± 0.11.7 ± 0.51.5 ± 0.7
        post-HD Phos (mol/L)0.8 ± 0.30.9 ± 0.20.8 ± 0.20.8 ± 0.3
    Medications
        ESA (%)9292100100
        beta-blockers (%)25880
        ACE inhibitors (%)0880
        calcium channel blockers (%)331780
        diuretics (%)0000
        other AHTs (%)00010
        iron (%)67337560

    • The data are presented as the means ± SD, unless otherwise indicated. ESA, erythropoietin–stimulating agent (darbepoetin or erythropoietin); AHT, antihypertensive medication; ACE, angiotensin-converting enzyme; HD, hemodialysis; CHD3, conventional thrice-weekly in-center hemodialysis; CSD, short-daily hemodialysis; HSD, at home hemodialysis; HN, home nocturnal hemodialysis; IHD, ischemic heart disease; Creat, creatinine; BUN, blood urea nitrogen; phos, phosphate.

  • Table 2.

    Blood pressure data

    BP (mmHg)CHD3CSDHSDHNP
    Mean±SDMean±SDMean±SDMean±SD
    Systolic (predialysis)146.222.7135.840.0123.317.0142.620.5—
    Systolic (peak)104.519.4117.336.9121.820.0159.728.50.007a
    0.003b
    <0.001c
    Systolic (postdialysis)127.722.4117.338.2123.217.9159.225.40.006a
    0.002b
    ΔSystolic (prepeak)−41.728.1−18.528.4−1.523.217.124.60.009d
    <0.001c
    0.006a
    Diastolic (predialysis)79.812.773.423.671.57.474.28.6—
    Diastolic (peak)62.716.867.520.873.59.981.412.60.007c
    Diastolic (postdialysis)70.312.565.219.771.78.183.211.00.015a
    ΔDiastolic (prepeak)−17.120.3−5.924.32.010.07.213.90.004c
    Mean arterial (predialysis)102.015.194.327.988.77.996.912.0—
    Mean arterial (peak)76.816.584.125.489.612.4107.716.7<0.001c
    Mean arterial (postdialysis)89.515.382.525.388.910.1108.515.00.008a

    • Δ, change.

    • ↵a CSD versus HN.

    • ↵b HSD versus HN.

    • ↵c CHD3 versus HN.

    • ↵d CHD3 versus HSD.

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Frequent Hemodialysis Schedules Are Associated with Reduced Levels of Dialysis-induced Cardiac Injury (Myocardial Stunning)
Helen J. Jefferies, Bhupinder Virk, Brigitte Schiller, John Moran, Christopher W. McIntyre
CJASN Jun 2011, 6 (6) 1326-1332; DOI: 10.2215/CJN.05200610
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