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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

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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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Published: Swansea, Wales, UK 2023
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
first_indexed 2023-09-22T13:32:31Z
last_indexed 2024-11-25T14:14:20Z
id cronfa64603
recordtype RisThesis
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spelling 2023-10-20T16:58:45.3710754 v2 64603 2023-09-22 Investigating the Cardiovascular Effects of 12-months Home Based Nocturnal Haemodialysis versus. Conventional Haemodialysis Treatment: a Non-randomised Controlled Pilot Study 207aae18891a6eb0512e2bb05c3643cb KAREN BROWN KAREN BROWN true false 2023-09-22 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. E-Thesis Swansea, Wales, UK Haemodialysis, nocturnal haemodialysis, cardiovascular outcomes, oxidative stress, inflammation, CT-CAC, hepcidin, IL-18 3 7 2023 2023-07-03 10.23889/SUthesis.64603 COLLEGE NANME COLLEGE CODE Swansea University Stephens, J. W., O’Baid, D., Mikhail A. I. and Prior, S. Doctoral M.D 2023-10-20T16:58:45.3710754 2023-09-22T14:26:41.0449884 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Biomedical Science KAREN BROWN 1 64603__28620__4e0d5be73374456db6208f5c7b95a868.pdf 2023_Brown_K.final.64603.pdf 2023-09-22T14:32:50.1635742 Output 3413858 application/pdf E-Thesis – open access true Copyright: The Author, Karen E. Brown, 2023. true eng
title Investigating the Cardiovascular Effects of 12-months Home Based Nocturnal Haemodialysis versus. Conventional Haemodialysis Treatment: a Non-randomised Controlled Pilot Study
spellingShingle Investigating the Cardiovascular Effects of 12-months Home Based Nocturnal Haemodialysis versus. Conventional Haemodialysis Treatment: a Non-randomised Controlled Pilot Study
KAREN BROWN
title_short Investigating the Cardiovascular Effects of 12-months Home Based Nocturnal Haemodialysis versus. Conventional Haemodialysis Treatment: a Non-randomised Controlled Pilot Study
title_full Investigating the Cardiovascular Effects of 12-months Home Based Nocturnal Haemodialysis versus. Conventional Haemodialysis Treatment: a Non-randomised Controlled Pilot Study
title_fullStr Investigating the Cardiovascular Effects of 12-months Home Based Nocturnal Haemodialysis versus. Conventional Haemodialysis Treatment: a Non-randomised Controlled Pilot Study
title_full_unstemmed Investigating the Cardiovascular Effects of 12-months Home Based Nocturnal Haemodialysis versus. Conventional Haemodialysis Treatment: a Non-randomised Controlled Pilot Study
title_sort Investigating the Cardiovascular Effects of 12-months Home Based Nocturnal Haemodialysis versus. Conventional Haemodialysis Treatment: a Non-randomised Controlled Pilot Study
author_id_str_mv 207aae18891a6eb0512e2bb05c3643cb
author_id_fullname_str_mv 207aae18891a6eb0512e2bb05c3643cb_***_KAREN BROWN
author KAREN BROWN
author2 KAREN BROWN
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institution Swansea University
doi_str_mv 10.23889/SUthesis.64603
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Biomedical Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Biomedical Science
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description 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.
published_date 2023-07-03T20:25:20Z
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score 11.04748

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