透析前血清钠水平改变了血液透析频率对左心室质量的影响：频繁血液透析网络试验。
The Predialysis Serum Sodium Level Modifies the Effect of Hemodialysis Frequency on Left-Ventricular Mass: The Frequent Hemodialysis Network Trials.
机构信息
Renal Research Institute, New York, New York, USA.
University Health Network Toronto, Toronto, Ontario, Canada.
出版信息
Kidney Blood Press Res. 2021;46(6):768-776. doi: 10.1159/000519339. Epub 2021 Oct 13.
INTRODUCTION
The Frequent Hemodialysis Network (FHN) Daily and Nocturnal trials aimed to compare the effects of hemodialysis (HD) given 6 versus 3 times per week. More frequent in-center HD significantly reduced left-ventricular mass (LVM), with more pronounced effects in patients with low urine volumes. In this study, we aimed to explore another potential effect modifier: the predialysis serum sodium (SNa) and related proxies of plasma tonicity.
METHODS
Using data from the FHN Daily and Nocturnal Trials, we compared the effects of frequent HD on LVM among patients stratified by SNa, dialysate-to-predialysis serum-sodium gradient (GNa), systolic and diastolic blood pressure, time-integrated sodium-adjusted fluid load (TIFL), and extracellular fluid volume estimated by bioelectrical impedance analysis.
RESULTS
In 197 enrolled subjects in the FHN Daily Trial, the treatment effect of frequent HD on ∆LVM was modified by SNa. When the FHN Daily Trial participants are divided into lower and higher predialysis SNa groups (less and greater than 138 mEq/L), the LVM reduction in the lower group was substantially higher (-28.0 [95% CI -40.5 to -15.4] g) than in the higher predialysis SNa group (-2.0 [95% CI -15.5 to 11.5] g). Accounting for GNa, TIFL also showed more pronounced effects among patients with higher GNa or higher TIFL. Results in the Nocturnal Trial were similar in direction and magnitude but did not reach statistical significance.
DISCUSSION/CONCLUSION: In the FHN Daily Trial, the favorable effects of frequent HD on left-ventricular hypertrophy were more pronounced among patients with lower predialysis SNa and higher GNa and TIFL. Whether these metrics can be used to identify patients most likely to benefit from frequent HD or other dialytic or nondialytic interventions remains to be determined. Prospective, adequately powered studies studying the effect of GNa reduction on mortality and hospitalization are needed.
简介
频繁血液透析网络（FHN）日间和夜间试验旨在比较每周进行 6 次与 3 次血液透析（HD）的效果。更频繁的中心血液透析显著降低左心室质量（LVM），而在尿量较低的患者中效果更为明显。在这项研究中，我们旨在探讨另一个潜在的效应修饰因子：透析前血清钠（SNa）和相关血浆渗透压的代表。
方法
利用 FHN 日间和夜间试验的数据，我们比较了在 SNa、透析液与透析前血清钠梯度（GNa）、收缩压和舒张压、时间整合钠调整的液体负荷（TIFL）以及生物电阻抗分析估计的细胞外液容量分层的患者中，频繁 HD 对 LVM 的影响。
结果
在 FHN 日间试验的 197 名入组患者中，频繁 HD 对 ∆LVM 的治疗效果受 SNa 影响。当将 FHN 日间试验参与者分为较低和较高透析前 SNa 组（<138 mEq/L 和 >138 mEq/L）时，较低组的 LVM 降低幅度明显更高（-28.0 [95% CI -40.5 至-15.4] g），而较高透析前 SNa 组则为（-2.0 [95% CI -15.5 至 11.5] g）。考虑到 GNa，TIFL 在 GNa 较高或 TIFL 较高的患者中也表现出更显著的效果。夜间试验的结果在方向和幅度上相似，但未达到统计学意义。
讨论/结论：在 FHN 日间试验中，较低透析前 SNa 和较高 GNa 和 TIFL 的患者中，频繁 HD 对左心室肥大的有利影响更为明显。这些指标是否可以用于识别最有可能从频繁 HD 或其他透析或非透析干预中获益的患者，仍有待确定。需要进行前瞻性、充分-powered 的研究，研究 GNa 降低对死亡率和住院率的影响。
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