Amin Tajerian, Tariq Shafi, Jason Zhang, Sobia Khan, Sandeep K Mallipattu, Andreas P Kalogeropoulos
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RKF was evaluated through timed 24h urine collections, with anuria defined as urine output <100 mL/day. LVM was assessed via magnetic resonance imaging at baseline and 12 months. Combined trial data were analyzed using log-transformed LVM to evaluate the impact of RKF on LVM change.</p><p><strong>Results: </strong>Among 332 patients from both FHN trials (170 frequent, 162 conventional HD), 189 (57%) were anuric at baseline. Baseline LVM did not differ between anuric and non-anuric patients (log LVM: 4.90±0.32 vs 4.85±0.40; p=0.18). At 12 months, both anuric and non-anuric patients experienced similar LVM reductions with frequent HD (mean change in log LVM: -0.11±0.23 vs -0.08±0.23; p=0.44). No association was found between baseline urine volume and LVM response (rho= -0.002, p=0.98 for frequent; rho=0.003, p=0.97 for conventional HD). Changes in urine volume over 12 months did not correlate with LVM changes. In an exploratory analysis, LVM reduction correlated with urine volume decline in men (rho=0.23; p<0.01) but not in women (rho= -0.19; p= 0.10; pinteraction = 0.003).</p><p><strong>Conclusions: </strong>Both anuric and non-anuric patients experienced similar LVM reductions with frequent HD, and no association between urine output and LVM response was observed in the FHN trials. 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Previous work suggested that the LVM benefits of frequent HD might be attenuated in the presence of residual kidney function (RKF). We hypothesized that patients without RKF would have greater LVM reduction with frequent HD compared to patients with RKF.</p><p><strong>Methods: </strong>We analyzed data from the Frequent Hemodialysis Network (FHN) Daily (in-center) and Nocturnal (home-based) Trials, which randomized patients with ESKD to either frequent or conventional HD over 12 months. RKF was evaluated through timed 24h urine collections, with anuria defined as urine output <100 mL/day. LVM was assessed via magnetic resonance imaging at baseline and 12 months. Combined trial data were analyzed using log-transformed LVM to evaluate the impact of RKF on LVM change.</p><p><strong>Results: </strong>Among 332 patients from both FHN trials (170 frequent, 162 conventional HD), 189 (57%) were anuric at baseline. Baseline LVM did not differ between anuric and non-anuric patients (log LVM: 4.90±0.32 vs 4.85±0.40; p=0.18). At 12 months, both anuric and non-anuric patients experienced similar LVM reductions with frequent HD (mean change in log LVM: -0.11±0.23 vs -0.08±0.23; p=0.44). No association was found between baseline urine volume and LVM response (rho= -0.002, p=0.98 for frequent; rho=0.003, p=0.97 for conventional HD). Changes in urine volume over 12 months did not correlate with LVM changes. In an exploratory analysis, LVM reduction correlated with urine volume decline in men (rho=0.23; p<0.01) but not in women (rho= -0.19; p= 0.10; pinteraction = 0.003).</p><p><strong>Conclusions: </strong>Both anuric and non-anuric patients experienced similar LVM reductions with frequent HD, and no association between urine output and LVM response was observed in the FHN trials. 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引用次数: 0
摘要
背景:在ESKD患者中,频繁(6次/周)血液透析(HD)比常规(3次/周)血液透析更能降低左心室质量(LVM)。先前的研究表明,频繁HD的LVM益处可能在残余肾功能(RKF)的存在下减弱。我们假设,与有RKF的患者相比,没有RKF的患者在频繁HD时有更大的LVM降低。方法:我们分析了来自频繁血液透析网络(FHN)每日(中心)和夜间(家庭)试验的数据,这些试验将ESKD患者随机分为频繁或常规HD,为期12个月。RKF通过定时收集24小时尿液来评估,无尿定义为尿输出结果:在两项FHN试验的332例患者中(170例频繁,162例常规HD), 189例(57%)在基线时无尿。无尿和非无尿患者的基线LVM无差异(对数LVM: 4.90±0.32 vs 4.85±0.40;p=0.18)。在12个月时,无尿和非无尿患者的LVM下降相似,伴有频繁的HD (log LVM的平均变化:-0.11±0.23 vs -0.08±0.23;p=0.44)。基线尿量与LVM反应之间没有关联(频繁尿量的rho= -0.002, p=0.98;常规HD的rho=0.003, p=0.97)。12个月内尿量的变化与LVM的变化无关。在一项探索性分析中,LVM减少与男性尿量下降相关(rho=0.23)。结论:无尿和非无尿患者的LVM减少与频繁的HD相似,并且在FHN试验中未观察到尿量与LVM反应之间的关联。这些数据表明,LVM对频繁HD的反应与基线残余肾功能无关。
Residual Kidney Function and Response of Left Ventricular Mass to Intensive Hemodialysis: The Frequent Hemodialysis Network Trials.
Background: Frequent (6 times/week) hemodialysis (HD) has been shown to reduce left ventricular mass (LVM) more than conventional (3 times/week) HD in patients with ESKD. Previous work suggested that the LVM benefits of frequent HD might be attenuated in the presence of residual kidney function (RKF). We hypothesized that patients without RKF would have greater LVM reduction with frequent HD compared to patients with RKF.
Methods: We analyzed data from the Frequent Hemodialysis Network (FHN) Daily (in-center) and Nocturnal (home-based) Trials, which randomized patients with ESKD to either frequent or conventional HD over 12 months. RKF was evaluated through timed 24h urine collections, with anuria defined as urine output <100 mL/day. LVM was assessed via magnetic resonance imaging at baseline and 12 months. Combined trial data were analyzed using log-transformed LVM to evaluate the impact of RKF on LVM change.
Results: Among 332 patients from both FHN trials (170 frequent, 162 conventional HD), 189 (57%) were anuric at baseline. Baseline LVM did not differ between anuric and non-anuric patients (log LVM: 4.90±0.32 vs 4.85±0.40; p=0.18). At 12 months, both anuric and non-anuric patients experienced similar LVM reductions with frequent HD (mean change in log LVM: -0.11±0.23 vs -0.08±0.23; p=0.44). No association was found between baseline urine volume and LVM response (rho= -0.002, p=0.98 for frequent; rho=0.003, p=0.97 for conventional HD). Changes in urine volume over 12 months did not correlate with LVM changes. In an exploratory analysis, LVM reduction correlated with urine volume decline in men (rho=0.23; p<0.01) but not in women (rho= -0.19; p= 0.10; pinteraction = 0.003).
Conclusions: Both anuric and non-anuric patients experienced similar LVM reductions with frequent HD, and no association between urine output and LVM response was observed in the FHN trials. These data suggest that the response of LVM to frequent HD is independent of baseline residual kidney function.