1
|
Roumeliotis A, Roumeliotis S, Chan C, Pierratos A. Cardiovascular Benefits of Extended-Time Nocturnal Hemodialysis. Curr Vasc Pharmacol 2021; 19:21-33. [PMID: 32234001 DOI: 10.2174/1570161118666200401112106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 01/09/2023]
Abstract
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.
Collapse
Affiliation(s)
- Athanasios Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christopher Chan
- University Health Network, Toronto General Hospital, Toronto, Canada
| | | |
Collapse
|
2
|
Rautavaara J, Kerola T, Kaartinen K, Vilpakka M, Aitkoski A, Anttonen O, Ahvonen J, Koistinen J, Vääräniemi K, Miettinen M, Ylitalo A, Laine K, Ojanen S, Nieminen T. Asystole episodes and bradycardia in patients with end-stage renal disease. Nephrol Dial Transplant 2021; 37:575-583. [PMID: 33527131 DOI: 10.1093/ndt/gfab023] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Knowledge of arrhythmias in patients with end-stage renal disease (ESRD) is mainly based on ambulatory electrocardiography (ECG) studies and observations during haemodialysis. We used insertable cardiac monitors to define the prevalence of arrhythmias, focusing on bradyarrhythmias, in ESRD patients treated with several dialysis modes including home therapies. Moreover, we assessed whether these arrhythmias were detected in baseline or ambulatory ECG recordings. METHODS Seventy-one patients with a subcutaneously insertable cardiac monitor were followed for up to three years. Asystole (≥4.0 secs) and bradycardia (heart rate <30 bpm for ≥4 beats) episodes, ventricular tachyarrhythmias and atrial fibrillation were collected and verified visually. A baseline ECG and a 24-48-hour ambulatory ECG were recorded at recruitment and once a year thereafter. RESULTS At recruitment, forty-four patients were treated in in-center haemodialysis, 12 in home haemodialysis and 15 in peritoneal dialysis. During a median follow-up of 34.4 months, 18 (25.4%) patients had either an asystolic or a bradycardic episode. The median length of each patient's longest asystole was 6.6 seconds and that of a bradycardia 13.5 seconds. Ventricular tachyarrhythmias were detected in 16 (23%) patients, and atrial fibrillation in 34 (51%) patients. In-center haemodialysis and type II diabetes were significantly more frequent among those with bradyarrhythmias whereas no bradyarrhythmias were found in home haemodialysis. No bradyarrhythmias were evident in baseline or ambulatory ECG recordings. CONCLUSIONS Remarkably many patients with ESRD had bradycardia or asystolic episodes, but these arrhythmias were not detected by baseline or ambulatory ECG.
Collapse
Affiliation(s)
- Joonas Rautavaara
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Tuomas Kerola
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Kati Kaartinen
- Department of Nephrology, Helsinki University Central Hospital, Abdominal Center, Helsinki, Finland
| | - Mari Vilpakka
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Atte Aitkoski
- Department of Internal Medicine, Kanta-Hame Central Hospital, Valkeakoski, Finland
| | - Olli Anttonen
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Jani Ahvonen
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Juhani Koistinen
- Department of Cardiology, Vaasa Central Hospital, Vaasa, Finland
| | - Kati Vääräniemi
- Department of Internal Medicine, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Marja Miettinen
- Department of Internal Medicine, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Antti Ylitalo
- Heart Center, Turku University Hospital, Turku, Finland
| | - Kaisa Laine
- Department of Nephrology, Satakunta Central Hospital, Pori, Finland
| | - Seppo Ojanen
- Department of Nephrology, Tampere University Hospital, Tampere, Finland
| | - Tuomo Nieminen
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.,Department of Internal Medicine, Helsinki University Central Hospital, Helsinki, Finland
| |
Collapse
|
3
|
Matsumoto Y, Mori Y, Kageyama S, Arihara K, Sato H, Nagata K, Shimada Y, Nojima Y, Iguchi K, Sugiyama T. Changes in QTc interval in long-term hemodialysis patients. PLoS One 2019; 14:e0209297. [PMID: 30605455 PMCID: PMC6317809 DOI: 10.1371/journal.pone.0209297] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/03/2018] [Indexed: 11/18/2022] Open
Abstract
Background Cardiovascular diseases, including sudden cardiac death (SCD), are the leading cause of death in hemodialysis (HD) patients. A prolonged QT interval on the electrocardiogram (ECG) is a risk factor for SCD in HD patients. This study investigated whether the heart rate-corrected QT (QTc) interval becomes prolonged along with dialysis vintage. Methods A total of 102 HD patients were retrospectively studied. Their ECG data were analyzed at 1, 4, and 7 years after HD initiation. The control group comprised 68 age-matched individuals who had normal renal function and two available ECG reports at an interval of more than 4 years. QTc was measured according to the Bazett formula. The association between QTc interval and dialysis vintage was studied. Additionally, clinically relevant variables related to QTc duration at 1 year after HD initiation were assessed. Results Average QTc interval at 4 and 7 years after HD initiation was significantly longer than that at 1 year after HD initiation (443, 445, and 437 ms) (p<0.05). On the other hand, QTc interval in the control group was 425 ms in the first year and 426 ms after an average of 6 years. They had no significant differences, although they were much shorter than that in HD patients. Multivariate regression analysis of baseline variables revealed that the corrected calcium levels (p = 0.041) and diabetes (p = 0.043) were independently associated with longer QTc interval. Conclusions The QTc interval at 1 year after HD initiation was longer than in the control subjects and was prolonged over several years of HD treatment. Providing clinical management with a focus on QTc interval may be helpful for reducing the incidence of SCD in HD patients.
Collapse
Affiliation(s)
- Yoshihiro Matsumoto
- Department of Nephrology and Hemodialysis, Shizuoka City Hospital, Shizuoka, Japan
- * E-mail:
| | | | | | | | | | | | - Yasushi Shimada
- Department of Nephrology and Hemodialysis, Shizuoka City Hospital, Shizuoka, Japan
| | - Yohichi Nojima
- Department of Nephrology and Hemodialysis, Shizuoka City Hospital, Shizuoka, Japan
| | - Koichiro Iguchi
- Department of Nephrology and Hemodialysis, Shizuoka City Hospital, Shizuoka, Japan
| | | |
Collapse
|
4
|
Liu X, Dai C. Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease. KIDNEY DISEASES 2016; 2:187-196. [PMID: 28232935 DOI: 10.1159/000449029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 08/10/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Residual renal function (RRF), defined as the ability of native kidneys to eliminate water and uremic toxins, is closely correlated with mortality and morbidity rates among patients receiving either peritoneal dialysis (PD) or hemodialysis (HD) via continuous clearance of middle-sized molecules and protein-bound solutes. Therefore, preserving RRF is considered to be one of the primary goals in managing patients with end-stage renal disease (ESRD). SUMMARY AND KEY MESSAGES In this article, we provide a review on the understanding and management of RRF in patients on dialysis. RRF may be estimated and measured by calculating the mean 24-hour urine creatinine level and urea clearance. Currently, several middle-sized molecules are reported but rarely used in practice. Many risk factors such as original renal diseases, dietary intake, and nephrotoxic agents impair RRF. Targeting such factors may halt the decline in RRF and offer better outcomes for patients on PD or HD. Except for in PD patients, RRF is a powerful predictor of survival in HD patients. RRF requires more clinical and research attention in the care of patients with ESRD on dialysis.
Collapse
Affiliation(s)
- Xin Liu
- Center for Kidney Diseases, 2nd Affiliated Hospital, Nanjing Medical University, Nanjing, PR China
| | - Chunsun Dai
- Center for Kidney Diseases, 2nd Affiliated Hospital, Nanjing Medical University, Nanjing, PR China
| |
Collapse
|
5
|
Sudden cardiac death in end stage renal disease: unlocking the mystery. J Nephrol 2014; 28:133-41. [PMID: 25391630 DOI: 10.1007/s40620-014-0151-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/09/2014] [Indexed: 01/05/2023]
Abstract
Sudden cardiac death (SCD) is a major cause of concern in end stage renal disease (ESRD), contributing to 70% of cardiovascular mortality and 27% of all-cause mortality in dialysis patients. Yet its mechanisms and pathogenesis remain largely obscure. This review discusses the potential reasons for an exaggerated risk of SCD in ESRD populations taking into account recent studies and registry data and additionally explores the reasons for the reported recent decline in SCD. The types of arrhythmias typical of the hemodialysis population are yet to be fully characterised and in this paper, we introduce an ongoing implantable loop recorder (ILR) based study in hemodialysis patients--CRASH ILR (Cardio Renal Arrhythmia Study in Haemodialysis patients using Implantable Loop Recorders). The findings of this study will hopefully guide the design and implementation of larger ILR based studies before undertaking larger scale interventional therapeutic trials in this high risk population.
Collapse
|