Table 2.
Levels of Potential Uremic Cardiovascular Toxins in Trials of Increased Intensity of Hemodialysis.
| HEMO [33,62] | FHN Daily Trial [34,63] | Extended Duration Nocturnal Hemodialysis [61] | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Standard | Increased Intensity | Standard | Increased Intensity | Standard | Increased Intensity | ||||
| N | 643 | 638 | 53 | 30 | 20 | 33 | |||
| HD treatments per week | 3 | 3 | 3 | 6 | 3 | 3 | |||
| Hours per treatment | 3.2 | 3.7 | 3.6 | 2.4 | 3.8 | 7.0 | |||
| Length of intervention | 34 months | 12 months | 12 months | ||||||
| Measure of dialysis intensity | Single pool Kt/V urea | Weekly standardized Kt/V urea | Urea reduction ratio (%) | ||||||
| 1.32 ± 0.09 | 1.71 ± 0.11 | 2.49 ± 0.2 | 3.54 ± 0.56 | 77 ± 6 | 84 ± 8 | ||||
| Clinical outcome | No difference in death, cardiac death, or composite of cardiac death and first cardiac hospitalization | No difference in composite of death or hospitalization unrelated to vascular access | None studied | ||||||
| Plasma Total (mg/dL) | Relative Difference (%) | Plasma Total (mg/dL) | Relative Difference (%) | Ratio Final to Baseline | Relative Difference (%) | ||||
| Standard | Increased intensity | Standard | Increased Intensity | Standard | Increased Intensity | ||||
| Urea nitrogen | 63 ± 19 | 57 ± 18 | −10 | 54 ± 14 | 45 ± 16 | −28 | 1.06 | 0.92 | -13 |
| Indoxyl Sulfate | 2.7 ± 1.3 | 2.4 ± 1.1 | −11 | 2.9 ± 1.1 | 2.5 ± 1.0 | −10 | 1.16 ± 0.73 | 1.1 ± 0.43 | -5 |
| P-Cresol Sulfate | 3.3 ± 1.7 | 3.4 ± 1.7 | 2 | 3.2 ± 1.4 | 3.3± 1.6 | 16 | 1.14 ± 0.66 | 1.02± 0.12 | -11 |
| Phenylacetylglutamine | 4.6 ± 3.0 | 4.3 ± 2.6 | −7 | 4.4 ± 2.3 | 3.3 ± 1.6 | −29 | - | - | - |
| TMAO | 0.80 ± 0.49 | 0.73 ± 0.49 | −9 | - | - | - | 1.13 ± 0.49 | 1.07 ± 0.55 | -5 |
| Kynurenine | - | - | - | - | - | - | 0.93 ± 0.31 | 1.07 ± .34 | 15 |
Values are mean ± standard deviation; TMAO: Trimethylamine N-oxide; HD: hemodialysis. HEMO plasma total values are from predialysis samples collected 3–8 months into intervention. Relative difference calculated from ratio of plasma total levels of increased intensity vs. standard groups during intervention. FHN plasma total values are from predialysis samples collected 12 months into intervention. Relative difference calculated from mean end/baseline ratio in increased vs. standard groups. Extended duration nocturnal hemodialysis samples collected predialysis 12 months into intervention. Relative difference calculated from mean end/baseline ratio in increased vs. standard groups.