American Heart Association endorses home dialysis in efforts to reduce cardiovascular risk
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The American Heart Association has published a statement supporting the use of home dialysis over in-center dialysis for patients with kidney and cardiovascular disease.
“Emerging evidence supports the overarching hypothesis that a more physiological approach (through avoidance of rapid fluctuations in both volume and solute and avoidance of hypervolemia and hypovolemia) to administering dialysis therapy, including in the home, may lead to improved cardiovascular outcomes,” Mark J. Sarnak, MD, MS, chair of the AHA Council on the Kidney in Cardiovascular Disease, and colleagues wrote.
The 19-page document, called “Cardiovascular Effects of Home Dialysis Therapies: A Scientific Statement from the American Heart Association,” is authored by 12 cardiologists and nephrologists and provides details on home dialysis therapies and on some of the comorbid conditions that patients with end-stage kidney disease experience, including hypertension and cardiovascular disease.
“Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage kidney disease, with rates of cardiovascular mortality [roughly] 10 to 20 times higher among patients receiving dialysis than in the general population,” Sarnak and colleagues wrote. “Reasons are multiple and include a high case fatality rate in patients who have cardiac events, a high prevalence of cardiovascular disease at the time of initiation of kidney replacement therapy, and a high prevalence of traditional and uremia-associated cardiovascular risk factors.”
Daniel E. Weiner, MD, MS, an associate professor in the department of medicine at Tufts University School of Medicine and co-author of the statement with other nephrologists, told Healio: “Cardiologists, especially those engaged in heart failure care, are influential, as kidney failure and cardiovascular disease, including heart failure, are frequently coexistent, and many cardiologists have longstanding, close relationships with their patients.”
Weiner said making all clinicians comfortable with kidney failure treatment options, such as home dialysis, was “critical for optimizing patient-centered care.
“My hope at least is that this statement helps meet that goal,” he said.
The researchers acknowledge that thrice-weekly in-center hemodialysis is the most common therapy performed worldwide but wrote that outcomes “are generally poor, with an [estimated] 15% annual mortality rate in the United States.”
The AHA said that its recommendation favoring use of home dialysis for patients with cardiovascular disease supports the goals of the Advancing American Kidney Health initiative, which has a goal of increasing the use of home dialysis, and “is aligned with the American Heart Association’s 2024 mission to champion a full and healthy life and health equity.
“We conclude that incorporation of interdisciplinary care models to increase the use of home dialysis therapies in an equitable manner will contribute to the ultimate goal of improving outcomes for patients with kidney failure and cardiovascular disease,” Sarnak and colleagues wrote.
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