Affiliation:
1. Department of Medicine Catholic University of Brasilia Brasília Brazil
2. Graduate Program of Physical Education Catholic University of Brasilia Brasília Brazil
3. Center for Transplantation Sciences, Department of Surgery Massachusetts General Hospital, Harvard Medical School Boston United States
4. Department of Kinesiology and Community Health University of Illinois Urbana‐Champaign Urbana IL USA
5. Graduate Program of Genomic Sciences and Biotechnology Catholic University of Brasilia Brasilia Brazil
6. Clinical Group Home Dialysis Center and RenalClass São Paulo Brazil
7. NefroClínicas, Premium Nephrology Clinic Brasilia Brazil
8. Centro Brasiliense de Nefrologia e Diálise Brasilia Brazil
9. Graduate Program of Gerontology Catholic University of Brasilia Brasilia Brazil
Abstract
AbstractBackgroundShort‐daily haemodialysis (SDH) has been strongly recommended over conventional haemodialysis (CHD) for end‐stage kidney disease patients, though few studies have directly compared the effects of these two haemodialysis (HD) modalities on clinical variables related to patient's health.MethodsWe conducted a cross‐sectional study in individuals undergoing HD, comparing epidemiological, clinical, metabolic, inflammatory, anthropometric, bone health/metabolism, and skeletal muscle function according to dialysis modality. One‐hundred seventy‐eight patients (20.8% females, 62 ± 2.5 years old), were analysed in this study, 86 (48%) of whom were undergoing CHD versus 92 (51%) who were undergoing SDH.ResultsSDH patients had significantly higher serum albumin levels (3.93 vs. 3.66 g/dL, P < 0.0001) and higher Kt/v (2.6 vs. 2.38, P < 0.0001). SDH group presented a significantly lower number of erythropoietin‐stimulating agents compared with CHD group (percentage: 53.3 vs. 83.7%, P < 0.0001) and had lower levels of serum phosphate (4.9 vs. 5.3 mg/dL, P = 0.004) and parathyroid hormone (PTH) (398.4 vs. 480.4 pg/mL, P < 0.001) compared with CHD patients. In terms of bone health and metabolism, SDH patients had significantly higher total BMD, femur BMD, lumbar BMD, and femoral neck BMD compared with CHD patients (all P < 0.05). SDH patients also had lower anti‐osteogenic and inflammatory biomarkers, including FGF23, sclerostin, TNF, IL‐18, IL‐17a, and C‐reactive peptide (all P < 0.05). CHD modality was demonstrated to be a risk factor for low BMD (odds ratio: 4.02; 95% CI: 1.59–10.2, P = 0.003). In terms of skeletal muscle function, SDH patients had significantly higher 6‐minute walking test (444.6 vs. 424.9 m, P = 0.04) and higher fat‐free mass (52.3 vs. 51.68 kg, P = 0.02) compared with CHD patients. Higher fat‐free mass and handgrip strength were associated with a 34% and 23% lower risk of low BMD, respectively. SDH patients had lower levels of the uremic toxin asymmetric dimethyl‐l‐arginine (ADMA) (1.8 vs. 2.07 μM, P = 0.002) and fasting blood glucose (132.6 vs. 141.7 mg/dL, P < 0.02) than CHD group. SDH patients also displayed higher levels of haemoglobin when compared with CHD group (11.9 vs. 10.2 g/dL, P < 0.0001).ConclusionsThe present study improves our understanding of the relationship between dialysis modality and clinical variables that may influence HD patient's health. Grip strength and lean mass were positively correlated with bone mineral density in HD patients regardless of dialysis modality. SDH was associated with better bone mineral density, inflammatory profile, and skeletal muscle function when compared with CHD patients. These findings provide more evidence of the clinical benefits of SDH that should be explored in greater detail.
Funder
Conselho Nacional de Desenvolvimento Científico e Tecnológico
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
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