频繁血液透析对心室容积和左心室重构的影响。
Effects of frequent hemodialysis on ventricular volumes and left ventricular remodeling.
机构信息
University Health Network, Toronto, Ontario, Canada;, †University of Utah, Salt Lake City, Utah;, ‡Stanford University, Stanford, California;, §Yale University School of Medicine, New Haven, Connecticut;, ‖University of Iowa, Iowa City, Iowa;, ¶Cleveland Clinic Foundation, Cleveland, Ohio;, *University of Illinois, Chicago, Illinois;, ††Renal Research Institute, New York, New York;, ‡‡University of California, San Diego, California;, §§Wake Forest University School of Medicine, Winston-Salem, North Carolina;, ‖‖Mount Sinai School of Medicine, New York, New York, ¶¶Ohio State University, Columbus, Ohio.
出版信息
Clin J Am Soc Nephrol. 2013 Dec;8(12):2106-16. doi: 10.2215/CJN.03280313. Epub 2013 Aug 22.
BACKGROUND AND OBJECTIVES
Higher left ventricular volume is associated with death in patients with ESRD. This work investigated the effects of frequent hemodialysis on ventricular volumes and left ventricular remodeling.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Frequent Hemodialysis Network daily trial randomized 245 patients to 12 months of six times per week versus three times per week in-center hemodialysis; the Frequent Hemodialysis Network nocturnal trial randomized 87 patients to 12 months of six times per week nocturnal hemodialysis versus three times per week predominantly home-based hemodialysis. Left and right ventricular end systolic and diastolic volumes, left ventricular mass, and ejection fraction at baseline and end of the study were ascertained by cardiac magnetic resonance imaging. The ratio of left ventricular mass/left ventricular end diastolic volume was used as a surrogate marker of left ventricular remodeling. In each trial, the effect of frequent dialysis on left or right ventricular end diastolic volume was tested between predefined subgroups.
RESULTS
In the daily trial, frequent hemodialysis resulted in significant reductions in left ventricular end diastolic volume (-11.0% [95% confidence interval, -16.1% to -5.5%]), left ventricular end systolic volume (-14.8% [-22.7% to -6.2%]), right ventricular end diastolic volume (-11.6% [-19.0% to -3.6%]), and a trend for right ventricular end systolic volume (-11.3% [-21.4% to 0.1%]) compared with conventional therapy. The magnitude of reduction in left and right ventricular end diastolic volumes with frequent hemodialysis was accentuated among patients with residual urine output<100 ml/d (P value [interaction]=0.02). In the nocturnal trial, there were no significant changes in left or right ventricular volumes. The frequent dialysis interventions had no substantial effect on the ratio of left ventricular mass/left ventricular end diastolic volume in either trial.
CONCLUSIONS
Frequent in-center hemodialysis reduces left and right ventricular end systolic and diastolic ventricular volumes as well as left ventricular mass, but it does not affect left ventricular remodeling.
背景与目的
左心室容积升高与终末期肾病患者的死亡相关。本研究旨在探讨频繁血液透析对心室容积和左心室重构的影响。
设计、地点、参与者和测量：频繁血液透析网络（Frequent Hemodialysis Network）每日试验将 245 名患者随机分为 12 个月的每周 6 次、每次 3 小时的中心血液透析组，或每周 6 次、每次 3 小时的主要家庭血液透析组；频繁血液透析网络夜间试验将 87 名患者随机分为 12 个月的每周 6 次夜间血液透析组，或每周 3 次主要家庭血液透析组。基线和研究结束时，通过心脏磁共振成像确定左、右心室收缩末期和舒张末期容积、左心室质量和射血分数。左心室质量/左心室舒张末期容积比作为左心室重构的替代标志物。在每个试验中，在预先定义的亚组之间测试了频繁透析对左心室或右心室舒张末期容积的影响。
结果
在每日试验中，与常规治疗相比，频繁血液透析可显著降低左心室舒张末期容积（-11.0%[95%置信区间，-16.1%至-5.5%]）、左心室收缩末期容积（-14.8%[-22.7%至-6.2%]）、右心室舒张末期容积（-11.6%[-19.0%至-3.6%]），且右心室收缩末期容积有降低趋势（-11.3%[-21.4%至 0.1%]）。在残余尿量<100ml/d 的患者中，频繁血液透析降低左、右心室舒张末期容积的幅度更大（P 值[交互项]=0.02）。在夜间试验中，左、右心室容积均无显著变化。在两个试验中，频繁透析干预对左心室质量/左心室舒张末期容积比均无显著影响。
结论
中心血液透析的频繁进行可降低左、右心室收缩末期和舒张末期容积以及左心室质量，但不会影响左心室重构。
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