The Predialysis Serum Sodium Level Modifies the Effect of Hemodialysis Frequency on Left-Ventricular Mass: The Frequent Hemodialysis Network Trials

Introduction: The Frequent Hemodialysis Network (FHN) Daily and Nocturnal trials aimed to compare the effects of hemodialysis (HD) given 6 versus 3 times per week. More frequent in-center HD significantly reduced left-ventricular mass (LVM), with more pronounced effects in patients with low urine vo...

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Autores principales:	Jochen G. Raimann, Christopher T. Chan, John T. Daugirdas, Thomas Depner, Tom Greene, George A. Kaysen, Alan S. Kliger, Peter Kotanko, Brett Larive, Gerald Beck, Robert McGregor Lindsay, Michael V. Rocco, Glenn M. Chertow, Nathan W. Levin
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	left-ventricular mass blood pressure fluid overload effect modification frequent hemodialysis Dermatology RL1-803 Diseases of the circulatory (Cardiovascular) system RC666-701 Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/70ad59e73a3044c1a79fa8becf075107
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spelling	oai:doaj.org-article:70ad59e73a3044c1a79fa8becf0751072021-11-11T10:40:44ZThe Predialysis Serum Sodium Level Modifies the Effect of Hemodialysis Frequency on Left-Ventricular Mass: The Frequent Hemodialysis Network Trials1420-40961423-014310.1159/000519339https://doaj.org/article/70ad59e73a3044c1a79fa8becf0751072021-10-01T00:00:00Zhttps://www.karger.com/Article/FullText/519339https://doaj.org/toc/1420-4096https://doaj.org/toc/1423-0143Introduction: The Frequent Hemodialysis Network (FHN) Daily and Nocturnal trials aimed to compare the effects of hemodialysis (HD) given 6 versus 3 times per week. More frequent in-center HD significantly reduced left-ventricular mass (LVM), with more pronounced effects in patients with low urine volumes. In this study, we aimed to explore another potential effect modifier: the predialysis serum sodium (SNa) and related proxies of plasma tonicity. Methods: Using data from the FHN Daily and Nocturnal Trials, we compared the effects of frequent HD on LVM among patients stratified by SNa, dialysate-to-predialysis serum-sodium gradient (GNa), systolic and diastolic blood pressure, time-integrated sodium-adjusted fluid load (TIFL), and extracellular fluid volume estimated by bioelectrical impedance analysis. Results: In 197 enrolled subjects in the FHN Daily Trial, the treatment effect of frequent HD on ∆LVM was modified by SNa. When the FHN Daily Trial participants are divided into lower and higher predialysis SNa groups (less and greater than 138 mEq/L), the LVM reduction in the lower group was substantially higher (−28.0 [95% CI −40.5 to −15.4] g) than in the higher predialysis SNa group (−2.0 [95% CI −15.5 to 11.5] g). Accounting for GNa, TIFL also showed more pronounced effects among patients with higher GNa or higher TIFL. Results in the Nocturnal Trial were similar in direction and magnitude but did not reach statistical significance. Discussion/Conclusion: In the FHN Daily Trial, the favorable effects of frequent HD on left-ventricular hypertrophy were more pronounced among patients with lower predialysis SNa and higher GNa and TIFL. Whether these metrics can be used to identify patients most likely to benefit from frequent HD or other dialytic or nondialytic interventions remains to be determined. Prospective, adequately powered studies studying the effect of GNa reduction on mortality and hospitalization are needed.Jochen G. RaimannChristopher T. ChanJohn T. DaugirdasThomas DepnerTom GreeneGeorge A. KaysenAlan S. KligerPeter KotankoBrett LariveGerald BeckRobert McGregor LindsayMichael V. RoccoGlenn M. ChertowNathan W. LevinKarger Publishersarticleleft-ventricular massblood pressurefluid overloadeffect modificationfrequent hemodialysisDermatologyRL1-803Diseases of the circulatory (Cardiovascular) systemRC666-701Diseases of the genitourinary system. UrologyRC870-923ENKidney & Blood Pressure Research, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	left-ventricular mass blood pressure fluid overload effect modification frequent hemodialysis Dermatology RL1-803 Diseases of the circulatory (Cardiovascular) system RC666-701 Diseases of the genitourinary system. Urology RC870-923
spellingShingle	left-ventricular mass blood pressure fluid overload effect modification frequent hemodialysis Dermatology RL1-803 Diseases of the circulatory (Cardiovascular) system RC666-701 Diseases of the genitourinary system. Urology RC870-923 Jochen G. Raimann Christopher T. Chan John T. Daugirdas Thomas Depner Tom Greene George A. Kaysen Alan S. Kliger Peter Kotanko Brett Larive Gerald Beck Robert McGregor Lindsay Michael V. Rocco Glenn M. Chertow Nathan W. Levin The Predialysis Serum Sodium Level Modifies the Effect of Hemodialysis Frequency on Left-Ventricular Mass: The Frequent Hemodialysis Network Trials
description	Introduction: The Frequent Hemodialysis Network (FHN) Daily and Nocturnal trials aimed to compare the effects of hemodialysis (HD) given 6 versus 3 times per week. More frequent in-center HD significantly reduced left-ventricular mass (LVM), with more pronounced effects in patients with low urine volumes. In this study, we aimed to explore another potential effect modifier: the predialysis serum sodium (SNa) and related proxies of plasma tonicity. Methods: Using data from the FHN Daily and Nocturnal Trials, we compared the effects of frequent HD on LVM among patients stratified by SNa, dialysate-to-predialysis serum-sodium gradient (GNa), systolic and diastolic blood pressure, time-integrated sodium-adjusted fluid load (TIFL), and extracellular fluid volume estimated by bioelectrical impedance analysis. Results: In 197 enrolled subjects in the FHN Daily Trial, the treatment effect of frequent HD on ∆LVM was modified by SNa. When the FHN Daily Trial participants are divided into lower and higher predialysis SNa groups (less and greater than 138 mEq/L), the LVM reduction in the lower group was substantially higher (−28.0 [95% CI −40.5 to −15.4] g) than in the higher predialysis SNa group (−2.0 [95% CI −15.5 to 11.5] g). Accounting for GNa, TIFL also showed more pronounced effects among patients with higher GNa or higher TIFL. Results in the Nocturnal Trial were similar in direction and magnitude but did not reach statistical significance. Discussion/Conclusion: In the FHN Daily Trial, the favorable effects of frequent HD on left-ventricular hypertrophy were more pronounced among patients with lower predialysis SNa and higher GNa and TIFL. Whether these metrics can be used to identify patients most likely to benefit from frequent HD or other dialytic or nondialytic interventions remains to be determined. Prospective, adequately powered studies studying the effect of GNa reduction on mortality and hospitalization are needed.
format	article
author	Jochen G. Raimann Christopher T. Chan John T. Daugirdas Thomas Depner Tom Greene George A. Kaysen Alan S. Kliger Peter Kotanko Brett Larive Gerald Beck Robert McGregor Lindsay Michael V. Rocco Glenn M. Chertow Nathan W. Levin
author_facet	Jochen G. Raimann Christopher T. Chan John T. Daugirdas Thomas Depner Tom Greene George A. Kaysen Alan S. Kliger Peter Kotanko Brett Larive Gerald Beck Robert McGregor Lindsay Michael V. Rocco Glenn M. Chertow Nathan W. Levin
author_sort	Jochen G. Raimann
title	The Predialysis Serum Sodium Level Modifies the Effect of Hemodialysis Frequency on Left-Ventricular Mass: The Frequent Hemodialysis Network Trials
title_short	The Predialysis Serum Sodium Level Modifies the Effect of Hemodialysis Frequency on Left-Ventricular Mass: The Frequent Hemodialysis Network Trials
title_full	The Predialysis Serum Sodium Level Modifies the Effect of Hemodialysis Frequency on Left-Ventricular Mass: The Frequent Hemodialysis Network Trials
title_fullStr	The Predialysis Serum Sodium Level Modifies the Effect of Hemodialysis Frequency on Left-Ventricular Mass: The Frequent Hemodialysis Network Trials
title_full_unstemmed	The Predialysis Serum Sodium Level Modifies the Effect of Hemodialysis Frequency on Left-Ventricular Mass: The Frequent Hemodialysis Network Trials
title_sort	predialysis serum sodium level modifies the effect of hemodialysis frequency on left-ventricular mass: the frequent hemodialysis network trials
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/70ad59e73a3044c1a79fa8becf075107
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The Predialysis Serum Sodium Level Modifies the Effect of Hemodialysis Frequency on Left-Ventricular Mass: The Frequent Hemodialysis Network Trials

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