Intensifying the HD prescription does not appear to have a direct effect on endothelial progenitor cell numbers; however, Chan et al9<\/sup> hypothesized that improved uremic toxin removal during daily, nocturnal hemodialysis can result in improved EPC number and function, improving overall cardiovascular parameters in dialysis patients. EPCs were isolated from 3 groups of age- and gender-matched subjects (normal control, n=10; conventional, thrice weekly HD (CHD), n=12; and daily, nocturnal HD (NHD), n=10 patients). None of the patients had symptomatic cardiovascular disease. EPC function was assessed by\u00a0in vitro<\/em>\u00a0testing of the migratory response to 50 ng\/mL of vascular endothelial growth factor. Left ventricular mass index (LVMI) was derived using 2D echocardiography. EPC number and function were markedly impaired in CHD patients despite higher doses of erythropoietin (Figure 1). In contrast, NHD patients had similar EPC biology to normal controls, and EPC number and function inversely correlated to pre-dialysis urea concentration and LVMI.<\/p>\n <\/p>\n <\/p>\n In addition to EPC parameters, several papers have described improvement in dyslipidemia with intensified hemodialysis. Since this also could not be a direct effect, it is assumed that intensified HD better removes one or more solutes of larger size that impairs normal lipid metabolism. Bugeja et al10<\/sup> conducted a prospective cohort study of 11 ESKD patients before and after conversion from conventional to daily nocturnal hemodialysis (5-6 times\/week), and obtained a 12-hour fasting lipid profile while on CHD and after switching to NHD. Three months after converting to NHD, and without dietary restriction, the authors reported a significant decrease in triglyceride (TG) levels, an increase in high density lipoprotein (HDL), and an increase in HDL\/total cholesterol (TC) ratio (Figure 2). TC and low-density lipoprotein (LDL) levels were unchanged.<\/p>\n <\/p>\n Although changes of this magnitude in lipid profile might be considered as a clinically significant response to any other lipid lowering therapy, it must be noted that randomized controlled trials with lipid lowering drugs (statins) have not shown any improvement in clinical outcomes in patients on maintenance HD11,12<\/sup>.<\/p>\n More recently, Jin et al1<\/sup> performed a non-randomized control study to examine the effects of longer nocturnal HD sessions (8 hours, thrice weekly) on endothelial dysfunction compared with conventional HD sessions (4 hours, thrice weekly). The authors used vascular ultrasound to measure flow-mediated dilation (FMD) of the brachial artery, finding that nocturnal HD is associated with an improvement in endothelial function as determined by FMD. Further, Jin et al1<\/sup> found a negative correlation between serum phosphate and FMD, implicating the improved removal of phosphorus with nocturnal HD with improved endothelial function. It is worth noting that while both treatment groups in this study received their HD treatments in-center, longer nocturnal treatments may be more easily performed at home.<\/p>\n GMO-001403\u00a0 Rev C\u00a0 11\/2024<\/span><\/p>\n![\"\"](\"https:\/\/staging.advancedrenaleducation.com\/wparep\/wp-content\/uploads\/2020\/03\/EP1-1024x438.png\")
<\/p>\nFigure 1: <\/strong>Endothelial precursor cell (EPC) number (left) and migratory function (right) in normal controls, conventional HD (CHD) and daily nocturnal HD (NHD). HPF: high-power field. * denotes p < 0.05 compared with normal and NHD (Adapted from Chan et al9<\/sup>).<\/h6>\n
![\"\"](\"https:\/\/staging.advancedrenaleducation.com\/wparep\/wp-content\/uploads\/2020\/03\/EP2-1024x573.png\")
<\/p>\nFigure 2: <\/strong>Plasma lipid profile on conventional HD (CHD) and 3 months after conversion to nocturnal HD (NHD). TC: total cholesterol; TG: triglyceride; HDL: high density lipoprotein; LDL: low density lipoprotein; * denotes p < 0.001 (Adapted from Bugeja et al10<\/sup>).<\/h6>\n
References:<\/h4>\n
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