Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life - A randomized controlled trial
Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life - A randomized controlled trial
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DOI：
10.1001/jama.298.11.1291
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发表时间：
2007-09-19
影响因子：
120.7
通讯作者：
Manns, Braden J.
中科院分区：
文献类型：
--
作者：
Culleton, Bruce F.;Walsh, Michael;Manns, Braden J.
血液透析患者的发病率和死亡率仍然过高。在提供透析的改变可能会导致改善patient outcomes.Objective To comparison the effects of frequent nocturnal hemodialysis vs conventional hemodialysis on change in left ventricular mass and health-related quality of life over 6 months.Design，Setting，and Participants A 2-group，parallel，randomized controlled trial carried out at 2 Canadian university centers between August 2004 and December 2006.共招募了52名接受血液透析的患者，干预参与者以1：1的比例随机分配接受每周6次夜间血液透析或每周3次常规血液透析。主要结果测量主要结果是左心室质量的变化，通过心血管磁共振成像测量。次要结局是患者报告的生活质量、血压、矿物质代谢和药物使用情况。结果频繁的夜间血液透析显著改善了主要结局（两组间平均左心室质量差异为15.3 g，95%置信区间[CI]为1.0 - 29.6 g; P = 0.04）。频繁的夜间血液透析并未显著改善生活质量（EuroQol 5-D指数较基线的变化差异为0.05; 95% CI为-0.07至0.17; P = 0.43）。然而，频繁的夜间血液透析与选定的肾脏特异性生活质量领域的临床和统计学显著改善相关（肾脏疾病影响P = .01，肾脏疾病负担P = .02）。频繁的夜间血液透析也与收缩压的改善有关（调整后P = 0.01）和矿物质代谢，包括减少或停用抗高血压药物夜间血液透析组16/26例，常规血液透析组3/25例; P <0.001）和口服磷酸盐结合剂（夜间血液透析组19/26例患者vs常规透析组3/25例患者; P <0.001）。没有好处，在贫血管理与夜间hemodialys.Conclusion初步研究表明，与传统的血液透析（每周3次），频繁的夜间血液透析改善左心室质量，降低血压药物的需要，改善了一些措施的矿物质代谢，并提高了选定的生活质量的措施。
Context Morbidity and mortality rates in hemodialysis patients remain excessive. Alterations in the delivery of dialysis may lead to improved patient outcomes.Objective To compare the effects of frequent nocturnal hemodialysis vs conventional hemodialysis on change in left ventricular mass and health-related quality of life over 6 months.Design, Setting, and Participants A 2-group, parallel, randomized controlled trial conducted at 2 Canadian university centers between August 2004 and December 2006. A total of 52 patients undergoing hemodialysis were recruited.Intervention Participants were randomly assigned in a 1:1 ratio to receive nocturnal hemodialysis 6 times weekly or conventional hemodialysis 3 times weekly.Main Outcome Measures The primary outcome was change in left ventricular mass, as measured by cardiovascular magnetic resonance imaging. The secondary outcomes were patient-reported quality of life, blood pressure, mineral metabolism, and use of medications.Results Frequent nocturnal hemodialysis significantly improved the primary outcome (mean left ventricular mass difference between groups, 15.3 g, 95% confidence interval [CI], 1.0 to 29.6 g; P = .04). Frequent nocturnal hemodialysis did not significantly improve quality of life (difference of change in EuroQol 5-D index from baseline, 0.05; 95% CI, -0.07 to 0.17; P = .43). However, frequent nocturnal hemodialysis was associated with clinically and statistically significant improvements in selected kidney-specific domains of quality of life (P = .01 for effects of kidney disease and P = .02 for burden of kidney disease). Frequent nocturnal hemodialysis was also associated with improvements in systolic blood pressure (P = .01 after adjustment) and mineral metabolism, including a reduction in or discontinuation of antihypertensive medications (16/26 patients in the nocturnal hemodialysis group vs 3/25 patients in the conventional hemodialysis group; P < .001) and oral phosphate binders (19/26 patients in the nocturnal hemodialysis group vs 3/25 patients in the conventional dialysis group; P < .001). No benefit in anemia management was seen with nocturnal hemodialysis.Conclusion This preliminary study revealed that, compared with conventional hemodialysis (3 times weekly), frequent nocturnal hemodialysis improved left ventricular mass, reduced the need for blood pressure medications, improved some measures of mineral metabolism, and improved selected measures of quality of life.