George Ting | PubMed Health

PubMed2006

Daily dialyses decrease plasma levels of brain natriuretic peptide (BNP), a biomarker of left ventricular dysfunction.

Brain natriuretic peptide or B-type natriuretic peptide (BNP) is a sensitive marker of heart disease. Plasma levels of BNP increase in left ventricular failure and determination of plasma BNP has become a useful tool in the diagnosis of heart failure. Hemodialysis (HD) patients may have elevated plasma levels of BNP, particularly predialysis, that correlate with echocardiographic signs of left ventricular dysfunction. High BNP levels are also a strong predictor of mortality in both nonrenal and HD patients. We studied plasma BNP levels in patients who changed from conventional thrice-weekly dialysis to daily dialysis 6 times a week while maintaining a total weekly time on dialysis of 12 hr. Twelve HD patients, mean age 55 years, had 4 hr of conventional thrice-weekly treatment for 4 weeks. Predialysis and postdialysis blood samples were obtained at the last dialysis. Patients were then dialyzed for 2 hr, 6 times weekly, for 4 weeks (daily dialysis). Again, predialysis and postdialysis blood samples were collected at the last HD. Brain natriuretic peptide plasma concentrations were determined by immunoradiometric assay. Predialysis BNP levels decreased from 194+/-51 ng/L (68+/-19 pmol/L; mean+SE) during thrice-weekly HD to 113+/-45 ng/L (41+/-18 pmol/L; p = 0.001) after 4 weeks on daily dialysis. With thrice-weekly HD, predialysis BNP levels were higher than postdialysis levels: 120+/-26 ng/L (39+/-8 pmol/L; p = 0.059). With daily dialysis, predialysis BNP levels did not differ significantly from postdialysis levels. Elevated predialysis plasma levels of BNP, considered sensitive and early markers of left ventricular dysfunction, decreased when patients were changed from conventional thrice-weekly HD to daily dialysis maintaining total hours of dialysis per week constant. Given the accumulated evidence that BNP is a biomarker of left ventricular dysfunction and can be used for risk stratification and guidance in pharmacotherapy of heart failure, daily dialysis appears to lead to less cardiac distress.

Adult↗

PubMed2004

Early clinical, quality-of-life, and biochemical changes of "daily hemodialysis" (6 dialyses per week).

BACKGROUND: Advantages associated with an increased frequency of hemodialysis have been reported previously. However, previous studies were either small or not controlled and did not detail early clinical, biochemical, quality-of-life, urea kinetic, and dynamic changes when patients switched from a conventional (3 times/wk) dialysis regimen to "daily" (6 times/wk) dialysis therapy when total weekly dialysis time was unchanged. METHODS: A prospective sequential study with 21 patients as their own controls was performed. A 4-week period of conventional thrice-weekly dialysis (N = 240 treatments) was followed immediately by a 4-week period of daily (ie, 6 times/wk) dialysis (N = 480 treatments), in which each treatment was half the length of a conventional dialysis treatment session. Clinical parameters and symptoms during and between dialysis treatments were graded, and urea-related parameters, blood chemistry results, and nutritional data were determined. RESULTS: Within 4 weeks of switching to this daily dialysis regimen, there were improvements in blood pressure, dialysis "unphysiology," intradialytic and interdialytic symptoms, and urea kinetics and dynamics. There were fewer machine alarms and less need for nursing interventions during dialysis. Nutrition and quality of life began to improve. There was no increase in blood access complications and no significant changes in blood chemistry results, hematologic parameters, or use of medications. CONCLUSION: In this short-term study, daily dialysis appears to be a safe, better, and more physiological method to deliver dialysis care to patients with end-stage renal disease.

Adult↗