E-Thesis 408 views 61 downloads
Investigating the Cardiovascular Effects of 12-months Home Based Nocturnal Haemodialysis versus. Conventional Haemodialysis Treatment: a Non-randomised Controlled Pilot Study / KAREN BROWN
Swansea University Author: KAREN BROWN
DOI (Published version): 10.23889/SUthesis.64603
Abstract
Living with CKD dramatically impacts an individual’s quality of life, often mandating frequent life-saving treatment in the form of haemodialysis; with its significant negative impact on cardiovascular morbidity and mortality. The cost to the individual and the NHS is substantial, with the UK ESRD p...
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Swansea, Wales, UK
2023
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| Institution: | Swansea University |
| Degree level: | Doctoral |
| Degree name: | M.D |
| Supervisor: | Stephens, J. W., O’Baid, D., Mikhail A. I. and Prior, S. |
| URI: | https://cronfa.swan.ac.uk/Record/cronfa64603 |
| Abstract: |
Living with CKD dramatically impacts an individual’s quality of life, often mandating frequent life-saving treatment in the form of haemodialysis; with its significant negative impact on cardiovascular morbidity and mortality. The cost to the individual and the NHS is substantial, with the UK ESRD population increasing by 8% year on year. The overall aim of this research was to examine the effect of nocturnal haemodialysis; an extended-hours therapy on plasma markers of oxidative stress and inflammation and compare cardiovascular outcomes with those attributed to conventional haemodialysis. The primary aim was to compare the effect of nocturnal haemodialysis on myocardial strain, as assessed by LV GLS using STE and cardiac biomarkers. The principal secondary aim was to assess the effect of nocturnal dialysis on the rate of increase of coronary calcification as a marker of coronary disease burden as assessed by CACS. In line with previous research, notably the landmark Alberta trial, FHN and FHNN trials, this thesis demonstrated an improvement in blood pressure control, serum phosphate and reduction in polypharmacy. The nocturnal group saw an improvement in LV GLS (p=0.04967) from a more significantly impaired baseline, a non-significant reduction in LVMi and no significant increase in CACS (6%). Contrasted with the conventional group where a 71.2% increase in CACS was observed (p=0.043). With regards to changes in systemic inflammation, a reduction in inflammatory marker IL-6 (p=0.04) was seen in the nocturnal group. Higher serum hepcidin levels were observed in CAC progressors than those with regression of CAC (p=0.045), where significant correlation of baseline hepcidin with relative CACS (p=0.037, r=0.9) was observed. This thesis provides new and detailed information on the assessment of cardiovascular disease in dialysis using LV GLS and CACS. Extended hours treatment with nocturnal haemodialysis significantly decreased progression of CAC compared with conventional haemodialysis. Progression appeared to be more dependent on levels of inflammation than deranged bone mineralisation with hepcidin the best predictor of an improvement in GLS and CAC progression. This information will add to the evidence-base and further enable clinicians to make person-centred therapy decisions for their ESRD patients. |
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| Keywords: |
Haemodialysis, nocturnal haemodialysis, cardiovascular outcomes, oxidative stress, inflammation, CT-CAC, hepcidin, IL-18 |
| College: |
Faculty of Medicine, Health and Life Sciences |