Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis
Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis
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DOI：
10.1046/j.1523-1755.2002.00362.x
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发表时间：
2002-06-01
影响因子：
19.6
通讯作者：
Pierratos, A
中科院分区：
文献类型：
--
作者：
Chan, CT;Floras, JS;Pierratos, A
背景左心室肥大（LVH）是透析人群死亡的独立危险因素。LVH可归因于多种因素，包括高血压、过量细胞外液（ECF）体积、贫血和尿毒症。夜间血液透析是一种新的肾脏替代疗法，似乎可以改善血压控制。这项观察性队列研究评估了从常规血液透析（CHD）转为夜间血液透析（NHD）对LVH的影响。在28例接受NHD至少2年（平均持续时间3.4 ± 1.2年）的患者（平均年龄44 ± 7岁）中，在转换前后测定血压（BP）、血红蛋白（Hb）、ECF体积（单频生物电阻抗）和左心室质量指数（LVMI）。为了进行比较，还研究了13名对照患者（平均年龄52 ± 15岁），他们在家中接受了一年或更长时间的自我护理CHD（平均持续时间2.8 ± 1.8年）。对照组同时测量血压、血红蛋白和左室重量指数。两个队列在基线时的年龄、抗高血压药物的使用、Hb、BP或LVMI方面无显著差异。从CHD转为NHD后，收缩压、舒张压和脉压均显著降低（145 ± 20至122 ± 13 mm Hg，P <0.001; 84 ± 15至74 ± 12 mm Hg，P = 0.02;从61 +/-12到49 +/-12 mm Hg，P = 0.002）和LVMI（从147 +/-42到114 +/-40 g/m2，P = 0.004）。在NHD队列中，抗高血压药物的处方数量也显著减少（从1.8减少到0.3，P <0.001），Hb增加。透析后ECF体积没有变化。LVMI与夜间血液透析时收缩压相关（r = 0.6，P = 0.001）。LVMI的变化与血压、血红蛋白的变化无相关性。相比之下，在同一时间段内，CHD队列中的BP、Hb或LVMI没有变化。NHD的血压降低伴随LVH的消退。
Background. Left ventricular hypertrophy (LVH) is an independent risk factor for mortality in the dialysis population. LVH has been attributed to several factors, including hypertension, excess extracellular fluid (ECF) volume, anemia and uremia. Nocturnal hemodialysis is a novel renal replacement therapy that appears to improve blood pressure control.Methods. This observational cohort study assessed the impact on LVH of conversion from conventional hemodialysis (CHD) to nocturnal hemodialysis (NHD). In 28 patients (mean age 44 +/- 7 years) receiving NHD for at least two years (mean duration 3.4 +/- 1.2 years), blood pressure (BP), hemoglobin (Hb), ECF volume (single-frequency bioelectrical impedance) and left ventricular mass index (LVMI) were determined before and after conversion. For comparison, 13 control patients (mean age 52 +/- 15 years) who remained on self-care home CHD for one year or more (mean duration 2.8 +/- 1.8 years) were studied also. Serial measurements of BP, Hb and LVMI were also obtained in this control group.Results. There were no significant differences between the two cohorts with respect to age, use of antihypertensive medications, Hb, BP or LVMI at baseline. After transfer from CHD to NHD, there were significant reductions in systolic, diastolic and pulse pressure (from 145 +/- 20 to 122 +/- 13 mm Hg, P < 0.001; from 84 +/- 15 to 74 +/- 12 mm Hg, P = 0.02; from 61 +/- 12 to 49 +/- 12 mm Hg, P = 0.002, respectively) and LVMI (from 147 +/- 42 to 114 +/- 40 g/m(2) , P = 0.004). There was also a significant reduction in the number of prescribed antihypertensive medications (from 1.8 to 0.3, P < 0.001) and an increase in Hb in the NHD cohort. Post-dialysis ECF volume did not change. LVMI correlated with systolic blood pressure (r = 0.6, P = 0.001) during nocturnal hemodialysis. There was no relationship between changes in LVMI and changes in BP or Hb. In contrast, there were no changes in BP, Hb or LVMI in the CHD cohort over the same time period.Conclusions. Reductions in BP with NHD are accompanied by regression of LVH.