American Journal of Nephrology

Patient-Oriented, Translational Research: Research Article

Faitatzidou D.a· Dipla K.b· Theodorakopoulou M.a· Koutlas A.b· Karagiannidis A.a· Alexandrou M.-E.a· Tsouchnikas I.a· Giamalis P.a· Dimitriadis C.a· Zafeiridis A.b· Papagianni A.a· Sarafidis P.a

Author affiliations

aDepartment of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
bExercise Physiology and Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece

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Article / Publication Details

First-Page Preview

Received: September 08, 2022
Accepted: November 08, 2022
Published online: December 08, 2022

Number of Print Pages: 11
Number of Figures: 3
Number of Tables: 3

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: https://www.karger.com/AJN

Abstract

Introduction: Cardiac arrhythmias are the most common cause of death in hemodialysis. Autonomic dysfunction plays a central role in this arrhythmogenic background. Previous studies on hemodialysis-related changes in heart rate variability (HRV) give contradictory results. This study investigated HRV indices both at rest and in response to physical and mental stimulation maneuvers at multiple time-points around and during the hemodialysis procedure. Methods: Autonomic function was assessed by linear and nonlinear HRV indices at predialysis, during dialysis (3 equal time-periods), postdialysis, and on the nondialysis day in 36 hemodialysis patients. Continuous measurement of beat-by-beat heart rate was recorded with Finometer-PRO (The Netherlands) at rest and after orthostatic, sit-to-stand, handgrip, and mental-arithmetic test. Results: The RMSSD, SD1, and SD2 indices significantly increased during dialysis (early-HD, mid-HD, late-HD periods) compared with the predialysis levels (p < 0.05) and returned to baseline postdialysis (RMSSD: 54.39 ± 83.73 vs. 137.98 ± 109.53* vs. 119.85 ± 97.34* vs. 144.47 ± 88.74* vs. 85.82 ± 121.43msec, *p < 0.05 vs. predialysis and postdialysis). No differences were detected in the above indices between the predialysis and nondialysis day. However, postdialysis, the HRV responses to orthostatic and sit-to-stand tests were more exaggerated than in the predialysis measurements (p < 0.05). The HRV responses both at resting and physical tests in the nondialysis day were similar to the predialysis levels. HRV indices in the mental arithmetic test during hemodialysis were much higher than at the nondialysis day (RMSSD: 77.05 [180.41] versus 19.75 [105.47] msec; p = 0.031). Conclusions: Hemodialysis causes marked changes in the autonomic function. Resting HRV indices return to baseline postdialysis, but HRV responses to physical stress remain exaggerated and return to baseline on the nondialysis day. Detecting patients with significant autonomic dysfunction may help towards reduction of arrhythmia risk through individualized approaches.

© 2022 S. Karger AG, Basel

References Saran R, Li Y, Robinson B, Abbott KC, Agodoa LYC, Ayanian J, et al. US renal data system 2015 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2016;67(3 Suppl 1):Svii, S1–305. Fliser D, Wiecek A, Suleymanlar G, Ortiz A, Massy Z, Lindholm B, et al. The dysfunctional endothelium in CKD and in cardiovascular disease: mapping the origin(s) of cardiovascular problems in CKD and of kidney disease in cardiovascular conditions for a research agenda. Kidney Int Suppl. 2011;1(1):6–9. Zoccali C, Vanholder R, Massy ZA, Ortiz A, Sarafidis P, Dekker FW, et al. The systemic nature of CKD. Nat Rev Nephrol. 2017;13(6):344–58. Lai S, Bagordo D, Perrotta AM, Gigante A, Gasperini ML, Muscaritoli M, et al. Autonomic dysfunction in kidney diseases. Eur Rev Med Pharmacol Sci. 2020;24(16):8458–68. Dipla K, Zafeiridis A, Koidou I, Geladas N, Vrabas IS. Altered hemodynamic regulation and reflex control during exercise and recovery in obese boys. Am J Physiol Heart Circ Physiol. 2010;299(6):H2090–2096. Electrophysiology TFESCNA. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93(5):1043–65. Chang Y-M, Shiao C-C, Chang K-C, Chen I-L, Yang C-L, Leu S-C, et al. Heart rate variability is an indicator for intradialytic hypotension among chronic hemodialysis patients. Clin Exp Nephrol. 2016;20(4):650–9. Huang Y-T, Chang Y-M, Chen I-L, Yang C-L, Leu S-C, Su H-L, et al. Heart rate variability during hemodialysis is an indicator for long-term vascular access survival in uremic patients. PLoS One. 2017;12(3):e0172212. Huang J-C, Kuo I-C, Tsai Y-C, Lee J-J, Lim L-M, Chen S-C, et al. Heart rate variability predicts major adverse cardiovascular events and hospitalization in maintenance hemodialysis patients. Kidney Blood Press Res. 2017;42(1):76–88. La Rovere MT, Pinna GD, Maestri R, Mortara A, Capomolla S, Febo O, et al. Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients. Circulation. 2003;107(4):565–70. Yang L, Zhao Y, Qiao B, Wang Y, Zhang L, Cui T, et al. Heart rate variability and prognosis in hemodialysis patients: a meta-analysis. Blood Purif. 2021;50(3):298–308. Huikuri HV, Perkiömäki JS, Maestri R, Pinna GD. Clinical impact of evaluation of cardiovascular control by novel methods of heart rate dynamics. Philos Trans A Math Phys Eng Sci. 2009;367:1223–38. Huikuri HV, Mäkikallio TH, Peng CK, Goldberger AL, Hintze U, Møller M. Fractal correlation properties of R-R interval dynamics and mortality in patients with depressed left ventricular function after an acute myocardial infarction. Circulation. 2000;101(1):47–53. Mäkikallio TH, Huikuri HV, Hintze U, Videbaek J, Mitrani RD, Castellanos A, et al. Fractal analysis and time- and frequency-domain measures of heart rate variability as predictors of mortality in patients with heart failure. Am J Cardiol. 2001;87(2):178–82. Rubinger D, Backenroth R, Sapoznikov D. Sympathetic nervous system function and dysfunction in chronic hemodialysis patients. Semin Dial. 2013;26(3):333–43. Forsström J, Forsström J, Heinonen E, Välimäki I, Antila K. Effects of haemodialysis on heart rate variability in chronic renal failure. Scand J Clin Lab Invest. 1986;46(7):665–70. Rubinger D, Revis N, Pollak A, Luria MH, Sapoznikov D. Predictors of haemodynamic instability and heart rate variability during haemodialysis. Nephrol Dial Transpl. 2004;19(8):2053–60. Ranpuria R, Hall M, Chan CT, Unruh M. Heart rate variability (HRV) in kidney failure: measurement and consequences of reduced HRV. Nephrol Dial Transpl. 2008;23(2):444–9. Barnas MG, Boer WH, Koomans HA. Hemodynamic patterns and spectral analysis of heart rate variability during dialysis hypotension. J Am Soc Nephrol. 1999;10(12):2577–84. Zygmunt A, Stanczyk J. Methods of evaluation of autonomic nervous system function. Arch Med Sci. 2010;6(1):11–8. Freeman R, Chapleau MW. Testing the autonomic nervous system. Handb Clin Neurol. 2013;115:115–36. Peltola MA, Seppänen T, Mäkikallio TH, Huikuri HV. Effects and significance of premature beats on fractal correlation properties of R-R interval dynamics. Ann Noninvasive Electrocardiol. 2004;9(2):127–35. Dipla K, Papadopoulos S, Zafeiridis A, Kyparos A, Nikolaidis MG, Vrabas IS. Determinants of muscle metaboreflex and involvement of baroreflex in boys and young men. Eur J Appl Physiol. 2013;113(4):827–38. Kamen PW, Krum H, Tonkin AM. Poincaré plot of heart rate variability allows quantitative display of parasympathetic nervous activity in humans. Clin Sci. 1996;91(2):201–8. Tarkiainen TH, Kuusela TA, Tahvanainen KUO, Hartikainen JEK, Tiittanen P, Timonen KL, et al. Comparison of methods for editing of ectopic beats in measurements of short-term non-linear heart rate dynamics. Clin Physiol Funct Imaging. 2007;27(2):126–33. Chou Y-H, Tsai T-J. Autonomic dysfunction in chronic kidney disease: an old problem in a new era. J Formos Med Assoc. 2016;115(9):687–8. Salman IM. Cardiovascular autonomic dysfunction in chronic kidney disease: a comprehensive review. Curr Hypertens Rep. 2015;17(8):59. Shen MJ, Zipes DP. Role of the autonomic nervous system in modulating cardiac arrhythmias. Circ Res. 2014;114(6):1004–21. La Rovere MT, Bigger JT, Marcus FI, Mortara A, Schwartz PJ. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes after Myocardial Infarction) Investigators. Lancet. 1998;351(9101):478–84. Galinier M, Pathak A, Fourcade J, Androdias C, Curnier D, Varnous S, et al. Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic heart failure. Eur Heart J. 2000;21(6):475–82. Forsström J, Forsström J, Heinonen E, Välimäki I, Antila K. Effects of haemodialysis on heart rate variability in chronic renal failure. Scand J Clin Lab Invest. 1986;46(7):665–70. Niu S-W, Huang J-C, Chen S-C, Lin HY-H, Kuo I-C, Wu P-Y, et al. Association between age and changes in heart rate variability after hemodialysis in patients with diabetes. Front Aging Neurosci. 2018;10:43. Tong Y-Q, Hou H-M. Alteration of heart rate variability parameters in nondiabetic hemodialysis patients. Am J Nephrol. 2007;27(1):63–9. Zhang Y, Wang J, Xing Y, Cui C, Cheng H, Chen Z, et al. Dynamics of cardiac autonomic responses during hemodialysis measured by heart rate variability and skin sympathetic nerve activity: the impact of interdialytic weight gain. Front Physiol. 2022;13:890536. Deussing K, Wendt R, Burger R, Gollasch M, Beige J. Reproducibility of heart rate variability revealed by repeated measurements during and after hemodialysis. Blood Purif. 2020;49(3):356–63. Rogovoy NM, Howell SJ, Lee TL, Hamilton C, Perez-Alday EA, Kabir MM, et al. Hemodialysis procedure-associated autonomic imbalance and cardiac arrhythmias: insights from continuous 14-day ECG monitoring. J Am Heart Assoc. 2019;8(19):e013748. Kim SH, Lim KR, Seo J-H, Ryu DR, Lee B-K, Cho B-R, et al. Higher heart rate variability as a predictor of atrial fibrillation in patients with hypertension. Sci Rep. 2022;12(1):3702. Vikman S, Mäkikallio TH, Yli-Mäyry S, Pikkujämsä S, Koivisto AM, Reinikainen P, et al. Altered complexity and correlation properties of R-R interval dynamics before the spontaneous onset of paroxysmal atrial fibrillation. Circulation. 1999;100(20):2079–84. Mäkikallio TH, Huikuri HV, Mäkikallio A, Sourander LB, Mitrani RD, Castellanos A, et al. Prediction of sudden cardiac death by fractal analysis of heart rate variability in elderly subjects. J Am Coll Cardiol. 2001;37(5):1395–402. Rosansky SJ, Rhinehart R, Whittman D, Menachery SJ. Comparison of autonomic function using Valsalva ratio and 30:15 postural ratio prior to and after haemodialysis treatment. Clin Auton Res. 1995;5(3):151–4. Lerma C, González H, Pérez-Grovas H, José MV, Infante O. Preserved autonomic heart rate modulation in chronic renal failure patients in response to hemodialysis and orthostatism. Clin Exp Nephrol. 2015;19(2):309–18. Sahin M, Kayatas M, Urun Y, Sennaroglu E, Akdur S. Performing only one cardiovascular reflex test has a high positive predictive value for diagnosing autonomic neuropathy in patients with chronic renal failure on hemodialysis. Ren Fail. 2006;28(5):383–7. Vaidya T, Chambellan A, de Bisschop C. Sit-to-stand tests for COPD: a literature review. Respir Med. 2017;128:70–7. Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA. 2000;284(11):1392–8. Sydó N, Sydó T, Gonzalez Carta KA, Hussain N, Farooq S, Murphy JG, et al. Prognostic performance of heart rate recovery on an exercise test in a primary prevention population. J Am Heart Assoc. 2018;7(7):e008143. Sipilä K, Tikkakoski A, Alanko S, Haarala A, Hernesniemi J, Lyytikäinen L-P, et al. Combination of low blood pressure response, low exercise capacity and slow heart rate recovery during an exercise test significantly increases mortality risk. Ann Med. 2019;51(7–8):390–6. Usui N, Nakata J, Uehata A, Ando S, Saitoh M, Kojima S, et al. Association of cardiac autonomic neuropathy assessed by heart rate response during exercise with intradialytic hypotension and mortality in hemodialysis patients. Kidney Int. 2022;101(5):1054–62. Frankenfield DL, Weinhandl ED, Powers CA, Howell BL, Herzog CA, St Peter WL. Utilization and costs of cardiovascular disease medications in dialysis patients in Medicare Part D. Am J Kidney Dis. 2012;59(5):670–81. Article / Publication Details

First-Page Preview

Received: September 08, 2022
Accepted: November 08, 2022
Published online: December 08, 2022

Number of Print Pages: 11
Number of Figures: 3
Number of Tables: 3

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: https://www.karger.com/AJN

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