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Daugirdas JT, Blake PG, Ing TS. Handbook of Dialysis. Philidelphia, PA: Lippincott, Williams, and Wilkins; 2007. Ischaemia in hypertensive patients is frequently caused by microvascular dysfunction; if atherosclerosis develops, epicardial coronary disease and, finally, acute coronary syndromes can be present as well. Verdecchia P, Angeli F, Gattobigio R, Sardone M, Porcellati C. Asymptomatic left ventricular systolic dysfunction in essential hypertension: prevalence, determinants, and prognostic value. Hypertension 2005;45:412-8. Home nocturnal hemodialysis is performed overnight while the patient and care partner are sleeping. It is a slower and longer treatment that more closely resembles healthy kidney function, which may be gentler on the heart compared to standard three-times weekly dialysis. 20

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Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217-23. Electrocardiogram (ECG) might detect atrial fibrillation and arrhythmias. Furthermore, it might show a prolonged terminal inverted P wave suggesting atrial enlargement or QRS voltage increases suggesting left ventricular hypertrophy 3. Complications Pauly RP, Gill JS, Rose CL, et al. Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients. Nephrol Dial Transplant. 2009;24:2915-2919. Kuruvilla S, Janardhanan R, Antkowiak P et al. Increased Extracellular Volume and Altered Mechanics Are Associated With LVH In Hypertensive Heart Disease, Not Hypertension Alone. JACC Cardiovasc Imaging. 2015;8(2):172-80. doi:10.1016/j.jcmg.2014.09.020 - Pubmed

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The main cause of hypertensive heart disease is elevated peripheral vascular resistance and arterial hypertension. Radiographic features Those definitions seem incomplete. Although LVH and heart failure are the most typical cardiac complications of hypertension, many patients may however complain, especially at the beginning of the process, of other symptoms of heart involvement. At end stages arrhythmias and coronary ischaemia can also lead to a worsening of the clinical profile. The definition provided by Frohlich et al20 seems rather inadequate because, as is now well established, the hemodynamic mechanism is not the only one involved in the development of LHV21.

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Nocturnal hemodialysis is associated with improved quality of life and patient outcomes — including improved survival. Performing more frequent nocturnal hemodialysis has shown similar 5 year survivability as deceased donor transplantation. 21 The reported benefits of home hemodialysis may not be experienced by all patients. Despite the health benefits that home and more frequent hemodialysis may provide to those with chronic kidney disease, these forms of therapy are not for everyone. Authors (year): WHO/ISH (1993), Framingham Study (1987),Fröhlich(1989), Ganau et al (1992), Iriarte et al (1993)

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Jaber BL, Schiller B, Burkart JM, et al. Impact of short daily hemodialysis on restless legs symptoms and sleep disturbances. Clin J Am Soc Nephrol. 2011;6(5):1049-1056. Performing more frequent hemodialysis treatments at home may improve your patients’ quality of life in addition to providing clinical benefits. Savage DD, Garrison RJ, Kannel WB, Levy D, Anderson SJ, Stokes J, et al. The spectrum of left ventricular hypertrophy in a general population sample: the Framingham study. Circulation 1987;75(Suppl 1):26-33.

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Over 1.1 billion people worldwide, one-fourth of all men and one-fifth of all women suffer from hypertension and the condition is in control in less than 20% of the affected population. It is also the main risk factor and cause of hypertensive heart disease 1. Associations Diagnosing diffuse myocardial fibrosis using T1 mapping and extracellular volume in the setting of hypertensive heart disease is anything but straightforward due to subtle elevations. In the absence of an accurately established local reference range, it is often difficult or even impossible to differentiate from normal individuals in the daily clinical environment.By treating 3.5–6 nights/week, for 6–10 hours per treatment, nocturnal HHD may provide significantly improved phosphorus and ß2-m clearance. 22,23