Document Detail


Predictors of haemodynamic instability and heart rate variability during haemodialysis.
MedLine Citation:
PMID:  15161953     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The pathogenesis of haemodialysis-induced hypotension is multifactorial and may include autonomic nervous system dysfunction. The present study was undertaken to (i) determine heart rate variability (HRV) in chronic haemodialysis patients without and with haemodynamic instability (hypotension-prone) during ultrafiltration and (ii) identify patients at risk and the predictors of dialysis-related hypotension. METHODS: HRV was evaluated in 56 chronic haemodialysis patients without (stable; n = 27) and with symptomatic hypotension episodes (unstable; n = 29) during daytime, haemodialysis and night-time periods. Logistic regression analysis was performed in a model that included clinical and biochemical data and HRV measurements. RESULTS: HRV was significantly reduced in haemodynamically unstable as compared with the stable patients. LF/HF ratio, an index representative of sympathovagal balance, was significantly lower in unstable patients, especially in those with ischaemic heart disease and diabetes mellitus. In a logistic regression model including clinical data and HRV measurements, ischaemic heart disease and left ventricular systolic dysfunction were found to be the main predictors of haemodynamic instability. CONCLUSIONS: These data suggest that haemodynamic instability is strongly associated with a decreased HRV and an impaired sympathovagal balance, suggesting disturbed autonomic control in uraemic patients with cardiac damage. Patients with ischaemic heart disease, reduced left ventricular systolic function and decreased HRV may be at the highest risk to be haemodynamically unstable during haemodialysis. The role of early detection and treatment of ischaemic heart disease in preventing symptomatic hypotensive episodes in these patients remains to be determined.
Authors:
Dvora Rubinger; Nina Revis; Arthur Pollak; Myron H Luria; Dan Sapoznikov
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Publication Detail:
Type:  Journal Article     Date:  2004-05-25
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  19     ISSN:  0931-0509     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-07-14     Completed Date:  2004-11-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  2053-60     Citation Subset:  IM    
Affiliation:
Nephrology and Hypertension Services, Hadassah University Hospital, POB 12000, Jerusalem 91120, Israel. rdvora@hadassah.org.il
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MeSH Terms
Descriptor/Qualifier:
Comorbidity
Female
Heart Rate*
Hemodynamics
Hemofiltration*
Humans
Hypotension / etiology
Kidney Failure, Chronic / epidemiology,  physiopathology,  therapy
Logistic Models
Male
Middle Aged
Myocardial Ischemia / epidemiology,  physiopathology
Sympathetic Nervous System / physiopathology
Ventricular Dysfunction, Left / epidemiology,  physiopathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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