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Improved blood pressure control with nocturnal hemodialysis: Review of clinical observations and physiologic mechanisms

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Abstract

Nocturnal hemodialysis (NHD) involves nightly (5–6 sessions per week), long (8–hour) home hemodialysis treatments. NHD therapy has recently attracted considerable attention owing to certain clear cardiovascular advantages with this method over conventional hemodialysis. In this article, we review the clinical reports of improved blood pressure control and normalization of left ventricular geometry associated with NHD therapy. Recent mechanistic studies exploring the reversal of the uremic hemodynamic state with NHD are also reviewed. The implication of these hemodynamic changes for the prospective renal transplant candidate are discussed.

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References and Recommended Reading

  1. Pierratos A, Ouwendyk M, Francoeur R, et al.: Nocturnal hemodialysis: three-year experience. J Am Soc Nephrol 1998, 9:859–868.

    PubMed  CAS  Google Scholar 

  2. Kooistra MP: Frequent prolonged home haemodialysis: three old concepts, one modern solution. Nephrol Dial Transplant 2003, 18:16–19.

    Article  PubMed  Google Scholar 

  3. Suri R, Depner TA, Blake PG, et al.: Adequacy of quotidian hemodialysis. Am J Kidney Dis 2003, 42 (Suppl1):42–48.

    Article  PubMed  Google Scholar 

  4. Pierratos A: Nocturnal home haemodialysis: an update on a 5 year experience. Nephrol Dial Transplant 1999, 14:2835–2840.

    Article  PubMed  CAS  Google Scholar 

  5. Brissenden JE, Pierratos A, Ouwendyk M, et al.: Improvement in quality of life with nocturnal hemodialysis [abstract]. J Am Soc Nephrol 1998, 9:168A.

    Google Scholar 

  6. Musci I, Hercz G, Uldall R, et al.: Control of serum phosphate without any phosphate binders in patients treated with nocturnal hemodialysis. Kidney Int 1998, 53:1399–1404.

    Article  Google Scholar 

  7. Hanly PJ, Pierratos A: Improvement in sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis. N Engl J Med 2001, 344:102–107. This study demonstrated that conversion of patients from conventional to nocturnal hemodialysis results in substantial improvement in the highly prevalent problem of sleep apnea.

    Article  PubMed  CAS  Google Scholar 

  8. Saleem MM: Hypertension in the hemodialysis population: a survey of 649 patients. Am J Kidney Dis 1995, 26:461–468.

    Google Scholar 

  9. London GM: Controversy on optimal blood pressure on haemodialysis: lower is not always better. Nephrol Dial Transplant 2001, 16:476–478.

    Google Scholar 

  10. Tomita J, Kimura G, Inoue T, et al.: Role of systolic blood pressure in determining prognosis of hemodialyzed patients. Am J Kidney Dis 1995, 25:405–412.

    PubMed  CAS  Google Scholar 

  11. Lynn KL, McGregor DO, Moesbergen T, et al.: Hypertension as a determinant of survival for patients treated with home dialysis. Kidney Int 2002, 62:2281–2287.

    Article  PubMed  Google Scholar 

  12. Silberberg JS, Barre PE, Prichard SS, Sniderman AD: Impact of left ventricular hypertrophy on survival in end-stage renal disease. Kidney Int 1989, 36:286–290.

    PubMed  CAS  Google Scholar 

  13. Laurent G: How to keep the dialysis patients normotensive? What is the secret of Tassin? Nephrol Dial Transplant 1997, 12:1104.

    Article  PubMed  CAS  Google Scholar 

  14. Innes A, Charra B, Burden RP, et al.: The effect of long, slow haemodialysis on patient survival. Nephrol Dial Transplant 1999, 14:919–922.

    Article  PubMed  CAS  Google Scholar 

  15. Fagugli RM, Reboldi G, Quintaliani G, et al.: Short daily hemodialysis: blood pressure control and left ventricular mass reduction in hypertensive hemodialysis patients. Am J Kidney Dis 2001, 38:371–376.

    PubMed  CAS  Google Scholar 

  16. Chan CT, Floras JS, Miller JA, et al.: Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis. Kidney Int 2002, 61:2235–2239. This study was the first to show that conversion of patients from conventional to nocturnal hemodialysis results not only in improved blood pressure control but also in significant regression of left ventricular hypertrophy.

    Article  PubMed  Google Scholar 

  17. Chan C, Floras JS, Miller JA, Pierratos A: Improvement in ejection fraction by nocturnal haemodialysis in end-stage renal failure patients with coexisting heart failure. Nephrol Dial Transplant 2002, 17:1518–1521. In this study, those patients with impaired left ventricular systolic function had significant improvement in ejection fraction after conversion from conventional to nocturnal hemodialysis.

    Article  PubMed  Google Scholar 

  18. Lindsay RM, Leitch R, Heidenheim AP, Kortas C: The London daily/nocturnal hemodialysis study: study design, morbidity, and mortality results. Am J Kidney Dis 2003, 42(Suppl1):5–12. This paper summarizes the results of a small pilot trial comparing conventional to short daily to nocturnal hemodialysis. Small numbers did not allow for conclusions on whether intensive dialysis is associated with morbidity or mortality benefit.

    Article  PubMed  Google Scholar 

  19. NIH seeking applications for short daily, nocturnal dialysis trial. Nephrol News Issues 2003, 17:30–31.

  20. Chan CT, Harvey PJ, Picton P, et al.: Short-term blood pressure, noradrenergic, and vascular effects of nocturnal home hemodialysis. Hypertension 2003, In press. This study demonstrates that conversion to nocturnal hemodialysis is associated with restoration of peripheral resistance. This vasodilation is associated with decreased norepinephrine levels and improved endothelial function.

  21. Converse RL, Jacobsen TN, Toto RD, et al.: Sympathetic overactivity in patients with chronic renal failure. N Engl J Med 1992, 327:1912–1918.

    Article  PubMed  Google Scholar 

  22. Leung RS, Bradley TD: Sleep apnea and cardiovascular disease. Am J Respir Crit Care Med 2001, 164:2147–2165.

    PubMed  CAS  Google Scholar 

  23. Chan CT, Hanly P, Gabor J, et al.: Impact of nocturnal hemodialysis on the variability of heart rate and duration of hypoxemia during sleep. Kidney Int 2003, In press. This study demonstrated that conversion of patients from conventional to nocturnal hemodialysis was associated with improved balance between sympathetic and vagal heart rate modulation during sleep.

  24. Morris STW, McMurray JJV, Rodger RSC, Jardine AG: Impaired endothelium dependent vasodilatation in uraemia. Nephrol Dial Transplant 2000, 15:1194–1200.

    Article  PubMed  CAS  Google Scholar 

  25. Cross JM, Donald A, Vallance PJ, et al.: Dialysis improves endothelial function in humans. Nephrol Dial Transplant 2001, 16:1823–1829.

    Article  PubMed  CAS  Google Scholar 

  26. Wolfe RA, Ashby VB, Milford EL, et al.: Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999, 341:1725–1730.

    Article  PubMed  CAS  Google Scholar 

  27. Fontan MP, Rodriguez-Carmona A, Bouza P, et al.: Delayed graft function after renal transplantation in patients undergoing peritoneal dialysis and hemodialysis. Adv Perit Dial 1996, 12:101–104.

    Google Scholar 

  28. McCormick BB, Pierratos A, Fenton S, et al.: Review of clinical outcomes in nocturnal hemodialysis patients after renal transplantation. Nephrol Dial Transplant 2003, In press. This paper describes higher frequency of intraoperative hypotension and a possible increase in delayed graft function among nocturnal hemodialysis patients who undergo renal transplantation.

  29. Scherrer U, Vissing SF, Morgan BJ, et al.: Cyclosporine-induced sympathetic activation and hypertension after heart transplantation. N Engl J Med 1990, 323:693–699.

    Article  PubMed  CAS  Google Scholar 

  30. Morris ST, McMurray JJ, Rodger RS, et al.: Endothelial dysfunction in renal transplant recipients maintained on cyclosporine. Kidney Int 2000, 57:1100–1106.

    Article  PubMed  CAS  Google Scholar 

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McCormick, B.B., Chan, C.T. Improved blood pressure control with nocturnal hemodialysis: Review of clinical observations and physiologic mechanisms. Current Science Inc 6, 140–144 (2004). https://doi.org/10.1007/s11906-004-0090-9

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