Key result
In-centre nocturnal hemodialysis was not associated with significant changes in epicardial (p=0.30) or paracardial (p=0.16) adipose tissue indices over 52 weeks compared to conventional hemodialysis.
Why the study?
Conversion from conventional to in-centre nocturnal hemodialysis is associated with LV mass regression, but the underlying mechanisms are not fully understood.
Does in-centre nocturnal hemodialysis reduce epicardial and paracardial adipose tissue volumes compared to conventional hemodialysis in patients on hemodialysis?
Cohort (n=67)
Blinded assessors
Yes
Does in-centre nocturnal hemodialysis reduce epicardial and paracardial adipose tissue volumes compared to conventional hemodialysis in patients on hemodialysis?
Conversion to in-centre nocturnal hemodialysis does not significantly alter epicardial or paracardial adipose tissue volumes over 12 months compared to conventional hemodialysis.
Answers are grounded in this paper and cite their sources.
Nocturnal hemodialysis does not support practice change for cardiac fat reduction; leaves open effects on other cardiovascular outcomes.
BACKGROUND: Conversion from conventional hemodialysis (CHD) to in-centre nocturnal hemodialysis (INHD) is associated with left ventricular (LV) mass regression, but the underlying mechanisms are not fully understood. Using cardiac MRI (CMR), we examined the effects of INHD on epicardial adipose tissue (EAT) and paracardial adipose tissue (PAT), and the relationships between EAT, PAT and LV remodeling, biomarkers of nutrition, myocardial injury, fibrosis and volume. METHODS: We conducted a prospective multicenter cohort study of 37 patients transitioned from CHD to INHD and 30 patients on CHD (control). Biochemical markers and CMR were performed at baseline and 52 weeks. CMR images were analyzed by independent readers, blinded to order and treatment group. Over 52 weeks, EAT index and PAT index did not change significantly in INHD and CHD groups (p = 0.21 and 0.14, respectively), and the changes in EAT index and PAT index did not differ significantly between INHD and CHD groups (p = 0.30 and 0.16, respectively). Overall, changes in EAT index inversely correlated with changes in LV end-systolic volume index (LVESVI) but not LV end-diastolic volume index (LVEDVI), LV mass index (LVMI), and LV ejection fraction (LVEF). Changes in PAT index inversely correlated with changes in LVESVI, LVMI and positively correlated with changes in LVEF. There were no correlations between changes in EAT index or PAT index with changes in albumin, LDL, triglycerides, troponin-I, FGF-23, or NT-proBNP levels over 52 weeks (all p > 0.30). CONCLUSIONS: INHD was not associated with any changes in EAT index and PAT index over 12 months. Changes in EAT index were not significantly associated with changes in markers of LV remodeling, nutrition, myocardial injury, fibrosis, volume status. In contrast, changes in PAT index, which paradoxically is expected to exert less paracrine effect on the myocardium, were correlated with changes in LVESVI, LVMI and LVEF. Larger and longer-term studies may clarify the role of PAT in cardiac remodeling with intensified hemodialysis. CLINICALTRIALS. GOV IDENTIFIER: NCT00718848.
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Cai et al. (2019) conducted a cohort in Hemodialysis (n=67). In-centre nocturnal hemodialysis (INHD) vs. Conventional hemodialysis (CHD) was evaluated on Changes in epicardial adipose tissue (EAT) index and paracardial adipose tissue (PAT) index (p=0.30 and 0.16). In-centre nocturnal hemodialysis was not associated with significant changes in epicardial (p=0.30) or paracardial (p=0.16) adipose tissue indices over 52 weeks compared to conventional hemodialysis.
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