Key result
Frequent hemodialysis reduces left ventricular mass by ~28 g in patients with lower serum sodium.
Why the study?
The effect of predialysis serum sodium and related plasma tonicity metrics as modifiers of the impact of frequent hemodialysis on left-ventricular mass was unclear.
RCT (n=279)
Open-label
Randomized
Yes
Sodium-stratified frequent hemodialysis effects require validation; leaves open modification of left ventricular mass response pending prospective trials.
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.
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Raimann et al. (2021) conducted an RCT in End-stage renal disease (patients on hemodialysis) (n=279). Frequent hemodialysis vs. Conventional hemodialysis (3 times per week) was evaluated on Change in left ventricular mass (LVM) among patients with predialysis serum sodium ≤138 mEq/L (MD -28.0 g, 95% CI -40.5 to -15.4, p=0.027 for interaction). Frequent hemodialysis reduced left ventricular mass by 28.0 g in patients with lower predialysis serum sodium (≤138 mEq/L), a significantly greater reduction than in patients with higher sodium levels.
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