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This news represents a big win for patients, enabling more hemodialysis patients to experience the benefits of more frequent treatments at home. It also provides an opportunity for greater control, ownership of self-care, increased independence, and flexibility in treatment scheduling. Authors (year): WHO/ISH (1993), Framingham Study (1987),Fröhlich(1989), Ganau et al (1992), Iriarte et al (1993) Weinhandl ED, Nieman KM, Gilbertson DT, Collins AJ. Hospitalization in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. Am J Kidney Dis. 2015;65(1):98-108. More recent definitions have also linked HHD to LVH. Frohlich et al defined HHD as the cardiac response to the afterload imposed on the left ventricle by the progressive increase in arterial pressure and peripheral vascular resistance as a consequence of hypertensive vascular disease20.
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The first definition of HHD was proposed in 1979 by the New York Heart Association. Hypertensive heart disease was defined as an anatomofunctional alteration characterized by left ventricular hypertrophy (LVH) and cardiac failure in patients with systemic hypertension19. With this definition, HHD was made equivalent to heart failure. Goldfarb-Rumyantzev AS, Leypoldt JK, Nelson N, Kutner NG, Cheung AK. A crossover study of short daily haemodialysis. Nephrol Dial Transplant. 2006;21:166-175. The growing body of clinical evidence that supports the life-changing benefits of more frequent hemodialysis is based primarily on treatments done 5-6 times per week.
An article from the E-Journal of the ESC Council for Cardiology Practice
Savage DD, Garrison RJ, Kannel WB, Levy D, Anderson SJ, Stokes J, et al. The spectrum of left ventricular hypertrophy in a general population sample: the Framingham study. Circulation 1987;75(Suppl 1):26-33.
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If left untreated hypertensive heart disease can lead to the following potentially life-threatening conditions:Verdecchia P, Reboldi G, Gattobigio R, Bentivoglio M, Borgioni C, Angeli F, et al. Atrial fibrillation in hypertension: predictors and outcome. Hypertension 2003;41:218-23. Nwabuo C & Vasan R. Pathophysiology of Hypertensive Heart Disease: Beyond Left Ventricular Hypertrophy. Curr Hypertens Rep. 2020;22(2):11. doi:10.1007/s11906-020-1017-9 - Pubmed Home nocturnal hemodialysis is performed overnight while the patient and care partner are sleeping. It is a slower and longer treatment that more closely resembles healthy kidney function, which may be gentler on the heart compared to standard three-times weekly dialysis. 20
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Dialysis is a journey and can involve multiple modalities. Regular communication and education about appropriate treatment options is important. Proactively in working with patients and educating them on potential future modalities, including more frequent HHD, may help ensure successful transitions and improved outcomes. Verdecchia P, Angeli F, Gattobigio R, Sardone M, Porcellati C. Asymptomatic left ventricular systolic dysfunction in essential hypertension: prevalence, determinants, and prognostic value. Hypertension 2005;45:412-8. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217-23. Pinciaroli AR. Restuls of daily hemodialysis in Catanzaro: 12-year experience with 22 patients treated for more than one year. Hemodial Int. 1998;2(1):12-17. Culleton BF, Walsh M, Klarenbach SW, et al. Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life. JAMA. 2007;298(11):1291–1299.Chronic blood pressure elevation induces a number of cardiac adaptative and detrimental changes in three main territories: left ventricle, coronary arteries, and left atrium.
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