Effect of Frequent or Extended Hemodialysis on Cardiovascular Parameters: A Meta-analysis

摘要: Background Increased left ventricular (LV) mass is a risk factor for cardiovascular mortality in patients with chronic kidney failure. More frequent or extended hemodialysis (HD) has been hypothesized to have beneficial effect on LV mass. Study Design Meta-analysis. Setting & Population MEDLINE literature search (inception April 2011), Cochrane Central Register of Controlled Trials and ClinicalTrials.gov using the terms "short daily HD," "daily "quotidian "frequent "intensive "nocturnal "home HD." Selection Criteria Studies Single-arm cohort studies (with pre- post-study evaluations) trials examining HD cardiac morphology function blood pressure parameters. hemofiltration, hemodiafiltration, peritoneal dialysis were excluded. Intervention Frequent (2-8 hours, >3 times weekly) (>4 3 compared conventional (≤4 HD. Outcomes Absolute changes function, including index (LVMI; primary) parameters (secondary). Results We identified 38 single-arm studies, 5 crossover trials, randomized controlled trials. By meta-analysis 23 study arms, significantly reduced LVMI from baseline (−31.2 g/m 2 , 95% CI, −39.8 −22.5; P ; −10.2 −3.7; = 0.01). Other morphologic showed similar improvements. There also significant decreases systolic, diastolic, mean number antihypertensive medications. Limitations Paucity Conclusions Conversion associated improvements ejection fraction, respectively, several parameters, which collectively might confer long-term benefit. clinical outcomes are needed.