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Left Atrial Remodeling Assessed by Cardiac MRI after Conversion from Conventional Hemodialysis to In-Centre Nocturnal Hemodialysis

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Abstract

Background

Left atrial (LA) volume is a well-established cardiovascular prognosticator in patients with end-stage renal disease. Although dialysis intensification is associated with left ventricular mass regression, there are limited data regarding LA remodeling. Using cardiac magnetic resonance imaging (CMR), we examined changes in LA size and function relative to ventricular remodeling and cardiac biomarkers after dialysis intensification.

Methods

In this prospective 2-centre cohort study, 37 patients receiving conventional hemodialysis (CHD, 4 h/session, 3×/week) were converted to in-centre nocturnal hemodialysis (INHD 7–8 h/session, 3×/week); 30 patients remained on CHD. CMR and biomarkers were performed at baseline and repeated at 52 weeks.

Results

After 52 weeks, there were no significant changes in the LA volumes or LA ejection fraction (EF) within either the CHD or INHD group, and no significant differences between the two groups. Correlations existed between changes in LA and LV end-diastolic volume index (EDVi, Spearman’s r = 0.69, p < 0.001), LA and LV end-systolic volume index (ESVi, r = 0.44, p = 0.001), LAEF and LVEF (r = 0.28, p = 0.04), LA and RV EDVi (r = 0.51, p < 0.001), LA and RV ESVi (r = 0.29, p = 0.039), and LA ESVi and LV mass index (r = 0.31, p = 0.02). At baseline, indexed LA volumes positively correlated with NT-proBNP, whereas LAEF negatively correlated with NT-proBNP and Troponin I. After 52 weeks, changes in biomarker levels did not correlate with changes in LA volume or EF.

Conclusion

There was no significant change in LA size or systolic function after conversion to INHD. The significant correlations between LA and ventricular remodeling and cardiac biomarkers suggest common underlying pathophysiologic mechanisms.

Trial registration

ClinicalTrials.gov Identifier: NCT00718848.

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Acknowledgements

We are grateful to our patients and our research assistants who made this research possible.

Funding

This study was funded by an operating grant from the Canadian Institutes of Health Research (MOP-89982) and a grant-in-aid from the Heart and Stroke Foundation (Project Number G-14-0005856). The study sponsors had no role in the study design, data collection or analysis, interpretation of the findings, writing the manuscript or the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Division of Cardiology, Terrence Donnelly Heart Centre, St. Michael’s Hospital, Toronto, ON, Canada

    Tamryn K. Law, Kim A. Connelly & Andrew T. Yan

  2. University of Toronto, Toronto, ON, Canada

    Tamryn K. Law, Ron Wald, Marc Goldstein, Djeven P. Deva, Anish Kirpalani, Rachel M. Wald, Kim A. Connelly & Andrew T. Yan

  3. Division of Nephrology, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Ron Wald & Marc Goldstein

  4. Department of Medical Imaging, Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael’s Hospital, Toronto, ON, Canada

    Gauri R. Karur, Djeven P. Deva & Anish Kirpalani

  5. Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong

    Ming-Yen Ng

  6. Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong

    Angela Y. M. Wang

  7. Division of Cardiology, Toronto General Hospital, Toronto, ON, Canada

    Rachel M. Wald

  8. Division of Nephrology, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada

    Mercedeh Kiaii

  9. Division of Radiology and Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada

    Jonathon Leipsic

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  1. Tamryn K. Law
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  2. Ron Wald
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  3. Marc Goldstein
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  9. Rachel M. Wald
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  12. Kim A. Connelly
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  13. Andrew T. Yan
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Corresponding author

Correspondence to Andrew T. Yan.

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Conflict of interest

A.Y.M.W has received speaker honorarium from Sanofi, and grant from Baxter. The rest of the authors declare that they have no conflict of interest.

Ethical approval

The Research Ethics Board of each site approved the study and all study participants provided written informed consent.

Informed consent

Informed consent was obtained from all study participants.

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Law, T.K., Wald, R., Goldstein, M. et al. Left Atrial Remodeling Assessed by Cardiac MRI after Conversion from Conventional Hemodialysis to In-Centre Nocturnal Hemodialysis. J Nephrol 32, 273–281 (2019). https://doi.org/10.1007/s40620-018-0522-2

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  • DOI: https://doi.org/10.1007/s40620-018-0522-2

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