The Association Between Conversion to In-centre Nocturnal Hemodialysis and Left Ventricular Mass Regression in Patients With End-Stage Renal Disease

Can J Cardiol. 2016 Mar;32(3):369-77. doi: 10.1016/j.cjca.2015.07.004. Epub 2015 Jul 9.


Background: In-centre nocturnal hemodialysis (INHD, 7-8 hours/session, 3 times/week) is an increasingly utilized form of dialysis intensification, though data on the cardiovascular benefits of this modality are limited.

Methods: In this prospective cohort study, we enrolled 67 prevalent conventional hemodialysis (CHD, 4 hours/session, 3 times/week) recipients at 2 medical centres in Canada, of whom 37 converted to INHD and 30 remained on CHD. The primary outcome was the change in left ventricular mass (LVM) after 1 year as assessed by cardiac magnetic resonance imaging. Secondary outcomes included changes in serum phosphate concentration, phosphate binder burden, haemoglobin, erythropoiesis stimulating agent usage, and blood pressure.

Results: Conversion to INHD was associated with a 14.2 (95% confidence interval [CI] 1.2-27.2) g reduction in LVM as compared with continuation on CHD. This result was maintained after adjustment for baseline imbalances between the groups and in ancillary analyses. There was a trend toward a larger drop in systolic blood pressure (9.8 [95% CI, -1.4-20.9] mm Hg) among INHD recipients with a significant reduction in the number of prescribed antihypertensive agents (0.7 [95% CI, 0.3-1.1] agents). Serum phosphate declined by 0.40 (95% CI, 0.16-0.63) mmol/L among INHD recipients without any difference in calcium-based phosphate binder requirements, as compared with those who remained on CHD.

Conclusions: Compared with continuation of CHD, conversion to INHD was associated with significant LVM regression and reduction in serum phosphate concentration at 1 year.

Trial registration: NCT00718848.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • British Columbia / epidemiology
  • Female
  • Follow-Up Studies
  • Heart Ventricles / pathology*
  • Heart Ventricles / physiopathology
  • Humans
  • Incidence
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / therapy*
  • Magnetic Resonance Imaging, Cine
  • Male
  • Middle Aged
  • Ontario / epidemiology
  • Phosphates / blood
  • Prospective Studies
  • Renal Dialysis / methods*
  • Time Factors
  • Ventricular Dysfunction, Left / diagnosis
  • Ventricular Dysfunction, Left / epidemiology
  • Ventricular Dysfunction, Left / etiology*
  • Ventricular Function, Left / physiology


  • Phosphates

Associated data