מתוך medicontext.co.il
By Bruce Dixon
CHICAGO (Reuters Health) – Regular nocturnal hemodialysis may reverse left ventricular hypertrophy (LVH) and improve the quality of life of kidney disease patients, according to a poster presentation at the ASN/ISN World Congress of Nephrology.
Researchers at Canada's Toronto General Hospital and Humber River Regional Hospital in Ontario said that their data show that six to seven nights of dialysis per week, instead of the usual three or four shorter daily sessions, may lower blood pressure and improve heart architecture.
Lead author, Dr. Christopher T. Chan, told Reuters Health that after two years on nocturnal hemodialysis, myocardial thickening was largely reversed in all but a few of the 28 patients with LVH enrolled in the study, as determined by echocardiography.
Dr. Chan said that "an abnormal left ventricular mass is defined as higher than 131 g/m² for men and greater than 100 g/m² for women." In this study, after transfer from conventional to nocturnal hemodialysis, left ventricular mass index (LVMI) dropped from 147.0 to 114.1 g/m² (p= 0.004), according to Dr. Chan.
"This regression was confined to those patients with LVH at baseline," he explained. In this group the mean LVM dropped from 162.9 to 117.9 g/m², whereas nocturnal hemodialysis had no effect in those with normal LVMI at baseline.
In the nocturnal dialysis group, Dr. Chan reported, systolic blood pressure was reduced from "145 mm Hg to 122 mm Hg, p < 0.001. Diastolic readings were reduced from 84 mm Hg to 74 mm Hg." Among the control group on traditional dialysis, blood pressure changes were not significant.
Dr. Chan told Reuters Health that once trained in home dialysis, patients have considerably more autonomy. "They actually set up their own dialysis machine, they put themselves on dialysis and go to bed. When they wake up, they unplug themselves and go about their business."
He added that "conventional dialysis is not a physiological maneuver. We're not meant to have our blood cleaned within four hours every other day. Traditional dialysis provides 10% to 15% of what a [healthy] kidney can do. With nocturnal dialysis, we can provide three to five times more clearance of toxins compared to traditional dialysis."
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