Abstract: FR-OR049

A Light Dialysis Session Makes a Heavy Heart: Extended Haemodialysis Offers Cardio-Protection

Session Information

  • Home Hemodialysis
    November 03, 2017 | Location: Room 295, Morial Convention Center
    Abstract Time: 04:42 PM - 04:54 PM

Category: Dialysis

  • 604 Home and Frequent Dialysis

Authors

  • Churchward, Darren R., University of Leicester, Leicester, United Kingdom
  • Hull, Katherine Leigh, University Hospitals of Leicester NHS Trust, Coventry, United Kingdom
  • March, Daniel Scott, University of Leicester, Leicester, United Kingdom
  • Graham-Brown, Matthew P.M., University Hospitals of Leicester NHS Trust, Coventry, United Kingdom
  • Burton, James, University of Leicester, Leicester, United Kingdom
Background

Internationally, there is a growing body of observational data that extended hours haemodialysis (HD) improves morbidity, mortality and quality of life. Limited experimental data are available comparing conventional HD (CD) to in-centre programmes of extended HD. This study examined the effects of extended in-centre nocturnal HD (INHD) on left ventricular geometry and circulating markers of cardiac injury, compared to CD.

Methods

: The MIDNIGHT trial (ISCTRN16672784) is a non-randomised controlled trial of INHD (3x5-8hours, n=10) vs CD (3x4hours, n=12), with patients matched for age, gender and HD vintage. Left ventricular mass index (LVMI) was assessed by cardiac magnetic resonance imaging; levels of heat shock protein 70 (HSP70), fibroblast growth factor-23 (FGF-23) and troponin-I (Trop-I) were analysed from blood samples taken prior to HD. All measures were completed at baseline and 6-months. LVMI results are shown as mean with standard deviation (Mean±SD); blood markers are presented as median with lower and upper quartiles (Mdn[LQ,UQ]).

Results

LVMI significantly reduced in the INHD group (63.6±20.7 vs 55.0±17.3, p=0.02) and tended to increase in the CD group (51.4±8.6 vs 54.6±11.1, p=0.46). No change to HSP70 was seen in either group. Reductions in FGF-23 were seen in the INHD group (489.7[156.3, 1515.0] vs 88.3[49.7,400.6], p=0.043) but not the CD group (399.24[174.1,4670] vs 657.3[158.9,1099.7], p=0.735). Similarly, no change to Trop-I in the INHD group (15[5.3,20.5] vs 6.5[0.0,25.0], p=0.917) but a trend to increase in the CD group (11.0[6.3,20.3] vs 15.0[8.8,38.8], p=0.066).

Conclusion

In this study, INHD patients demonstrated favourable changes in circulating biomarkers of cardiovascular disease as well as regression of left ventricular hypertrophy, compared to controls. These results provide further evidence that extended HD regimens may improve cardiovascular outcomes and therefore warrant further investigation.