Frequent Hemodialysis Schedules Are Associated with Reduced Levels of Dialysis-induced Cardiac Injury (Myocardial Stunning)
Frequent Hemodialysis Schedules Are Associated with Reduced Levels of Dialysis-induced Cardiac Injury (Myocardial Stunning)
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DOI：
10.2215/cjn.05200610
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发表时间：
2011-06-01
影响因子：
9.8
通讯作者：
McIntyre, Christopher W.
中科院分区：
文献类型：
--
作者：
Jefferies, Helen J.;Virk, Bhupinder;McIntyre, Christopher W.
背景与目的反复血液透析(HD)所致的缺血性心脏损伤(心肌顿抑)是常见的，并与高超滤(UF)要求、透析中低血压、长期收缩功能丧失、心血管事件的可能性增加和死亡相关。与常规每周三次透析相比，更频繁的HD方案与更低的UF需求和更好的血流动力学耐受性、改善心血管结局和降低死亡率相关。设计、设置、参与者和测量一项横断面研究，对46名血液透析患者进行了为期3个月的横断面研究，比较了四组接受当前常规治疗的四组患者：常规每周三次HD(CHD3)；更频繁的HD每周在中心(CSD)和在家(HSD)进行五到六次；以及家庭夜间HD(HN)。系列超声心动图定量评估局部收缩功能，以确定透析中左室室壁运动异常(RWMA)。测定心肌肌钙蛋白T(CTnT)、N末端前激素脑利钠肽(NT-proBNP)和炎症标志物。CSD组和HSD组透析内收缩压下降，FIN组无明显变化。每个患者的平均RWMAs随着透析强度的增加而减少(CHD3和GT；CSD和GT；HSD和GT；HN)。HOME组高敏C反应蛋白水平较低，cTnT和NT-proBNP水平随透析频率增加而降低。结论与常规透析相比，频繁透析可减少透析所致心肌顿抑。这可能有助于改善与频繁HD治疗相关的结果。临床J am Soc肾病6：1326-1332,2011。DOI：10.2215/CJN.05200610
Background and objectives Recurrent hemodialysis (HD)-induced ischemic cardiac injury (myocardial stunning) is common and associated with high ultrafiltration (UF) requirements, intradialytic hypotension, long-term loss of systolic function, increased likelihood of cardiovascular events, and death. More frequent HD regimens are associated with lower UF requirements and improved hemodynamic tolerability, improved cardiovascular outcomes, and reduced mortality compared with conventional thrice-weekly HD. This study investigated the hypothesis that modification of UF volume and rate with more frequent HD therapies would abrogate dialysis-induced myocardial stunning.Design, settings, participants, & measurements A cross-sectional study of 46 patients established on hemodialysis >3 months compared four groups receiving the current range of quotidian therapies: conventional thrice-weekly HD (CHD3); more-frequent HD five to six times/week in a center (CSD) and at home (HSD); and home nocturnal HD (HN). Serial echocardiography quantitatively assessed regional systolic function to identify intradialytic left ventricular regional wall motion abnormalities (RWMAs). Cardiac troponin T (cTnT), N-terminal prohormone brain natriuretic peptide (NT-proBNP), and inflammatory markers were quantified.Results More frequent HD regimens were associated with lower UF volumes and rates compared with CHD3. Intradialytic fall in systolic BP was reduced in CSD and HSD groups and abolished in FIN group. Mean RWMAs per patient reduced with increasing dialysis intensity (CHD3 > CSD > HSD > HN). Homebased groups demonstrated lower high-sensitivity C-reative protein levels, with trends to lower cTnT and NT-proBNP levels in the more frequent groups.Conclusions Frequent HD regimes are associated with less dialysis-induced myocardial stunning compared with conventional HD. This may contribute to improved outcomes associated with frequent HD therapies. Clin J Am Soc Nephrol 6: 1326-1332, 2011. doi: 10.2215/CJN.05200610