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

Autor:	Raimann JG; Renal Research Institute, New York, New York, USA., Chan CT; University Health Network Toronto, Toronto, Ontario, Canada., Daugirdas JT; University of Illinois College of Medicine, Chicago, Illinois, USA., Depner T; University of California Davis, Davis, California, USA., Greene T; University of Utah, Salt Lake City, Utah, USA., Kaysen GA; University of California Davis, Davis, California, USA., Kliger AS; Yale New Haven Health System, New Haven, Connecticut, USA., Kotanko P; Renal Research Institute, New York, New York, USA.; Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA., Larive B; Cleveland Clinic Foundation, Cleveland, Ohio, USA., Beck G; Cleveland Clinic Foundation, Cleveland, Ohio, USA., Lindsay RM; Western University, London, Ontario, Canada., Rocco MV; Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Chertow GM; Stanford University School of Medicine, Stanford, California, USA., Levin NW; Renal Research Institute, New York, New York, USA.; Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA.
Jazyk:	angličtina
Zdroj:	Kidney & blood pressure research [Kidney Blood Press Res] 2021; Vol. 46 (6), pp. 768-776. Date of Electronic Publication: 2021 Oct 13.
DOI:	10.1159/000519339
Abstrakt:	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. (© 2021 The Author(s). Published by S. Karger AG, Basel.)
Databáze:	MEDLINE
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