Left ventricular (LV) remodeling is defined as ''the genomic expression resulting in molecular, c... more Left ventricular (LV) remodeling is defined as ''the genomic expression resulting in molecular, cellular, and interstitial changes that are manifested clinically as changes in size, shape, and function of the heart after cardiac injury" (1). In ESRD, LV remodeling manifests features of both concentric and eccentric LV hypertrophy, resulting from enlarged LV volumes and increased LV wall thickness (2). As we discuss here, LV mass can change because of a change in LV wall thickness, LV cavity size, or both. Increased LV mass, increased LV end-diastolic volume (LVEDV), and changes in LV geometry (LV mass/LVEDV) are all associated with poor prognosis in these patients (3,4). The Frequent Hemodialysis Network (FHN) trial is the first large-scale randomized controlled trial of frequent daily and nocturnal dialysis versus conventional dialysis (5). FHN investigators previously demonstrated that, compared with conventional hemodialysis, frequent daily hemodialysis results in a significantly greater reduction in LV mass, as determined by cardiac magnetic resonance imaging (MRI) (6). In this issue of CJASN, this group reports that frequent daily dialysis resulted in greater reductions in LV and right ventricular (RV) volumes without significant changes in LV geometry (7). In addition, reductions in both LV mass and LVEDV with frequent dialysis were significantly correlated with reductions in predialysis systolic BP (6,7). Here we present a brief overview of the literature on the effects of dialysis on LV remodeling, discuss likely mechanisms underlying the findings of the current study, and reflect on implications for future investigation.
Left ventricular (LV) remodeling is defined as ''the genomic expression resulting in molecular, c... more Left ventricular (LV) remodeling is defined as ''the genomic expression resulting in molecular, cellular, and interstitial changes that are manifested clinically as changes in size, shape, and function of the heart after cardiac injury" (1). In ESRD, LV remodeling manifests features of both concentric and eccentric LV hypertrophy, resulting from enlarged LV volumes and increased LV wall thickness (2). As we discuss here, LV mass can change because of a change in LV wall thickness, LV cavity size, or both. Increased LV mass, increased LV end-diastolic volume (LVEDV), and changes in LV geometry (LV mass/LVEDV) are all associated with poor prognosis in these patients (3,4). The Frequent Hemodialysis Network (FHN) trial is the first large-scale randomized controlled trial of frequent daily and nocturnal dialysis versus conventional dialysis (5). FHN investigators previously demonstrated that, compared with conventional hemodialysis, frequent daily hemodialysis results in a significantly greater reduction in LV mass, as determined by cardiac magnetic resonance imaging (MRI) (6). In this issue of CJASN, this group reports that frequent daily dialysis resulted in greater reductions in LV and right ventricular (RV) volumes without significant changes in LV geometry (7). In addition, reductions in both LV mass and LVEDV with frequent dialysis were significantly correlated with reductions in predialysis systolic BP (6,7). Here we present a brief overview of the literature on the effects of dialysis on LV remodeling, discuss likely mechanisms underlying the findings of the current study, and reflect on implications for future investigation.
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