Dynamic Novel Cardiac Imaging Parameters in Home Nocturnal Hemodialysis

Abstract

BACKGROUND: Most patients on dialysis have left ventricular hypertrophy (L VH) as seen on cardiac imaging. Nocturnal home hemodialysis (NHD) may produce regression of L VH and may also improve other cardiac and non-cardiac parameters. OBJECTNE: To evaluate whether NHD improves cardiac parameters as assessed by cardiac imaging, and to explore whether this improvement correlates with any of the other measures of health we used. METHODS: TIns observational cohort study involved information from cardiac imaging, medical history, clinical examination, lab data, and quality of life data from five patients, collected when they began NHD and again at one-year follow-up. RESULTS: Left ventricular mass index (LVMI) decreased for all patients at follow-up from 35±2g/m2 at baseline to 33±2g/m2 at 12 months (p<O.0009). Left atrial volume index (LA VI) also decreased for all patients at follow-up, from 140±2 to 136±3mL/m2 (p<O.009). Diastolic dysfunction improved in almost all patients (p=O.06) at follow-up. Pre-dialysis systolic blood pressure decreased from 118±lJto 107±12l11!11Hg (p<O.02) at follow-up. ' : . ! ',- ','''!" ! ::.' CONCLUSION: NHD improves LVMI, LA VI, and blood pressure within one year of the switch from conventional in-center hemodialysis. Converting to NHD is also associated with a strong trend towards improvement of diastolic dysfunction.