| Summary: | Introduction: Heart rate variability (HRV) analysis is a non-invasive tool for assessing the cardiac health. There is evidence that the cardiac autonomic system and central hemodynamics respond to hemodialysis. The aim of this work is to compare HRV parameters and augmentation index (AIx) between intra- and interdialytic periods in patients with end-stage renal disease.
Methods: All 24-h electrocardiogram data were obtained using the Lifecard CF digital Holter recorder (Delmar Reynolds/Spacelabs, Germany) and 24-h pulse wave analysis (PWA) measurements were taken with the Mobil-O-Graph 24h PWA (I.E.M. GmbH, Germany) within the ISAR hemodialysis study. Two-hundred patients (132 men / 68 women: 61+−16 years) were included. HRV was analyzed in the time- and frequency-domain in 5-min segments. AIx values and HRV parameters were averaged for intra- and interdialytic periods.
Results: The low to high frequency ratio (LF/HF) as a representative of sympathovagal balance (2.85 vs 3.36, p<0.01) and the augmentation index (AIx) (26.9 vs 28.5 %, p<0.01) were significantly decreased during dialysis. Whereas, the root mean square of successive differences (RMSSD) reflecting the parasympathetic cardiovascular modulation was significantly increased during hemodialysis session (13.9 vs 13.7 ms, p<0.05) (see Table).
Conclusions: The present work confirms previous findings of changes in HRV and AIx between intra- and interdialytic periods in a larger cohort [1,2]. The data suggests a reduced arterial stiffness in the context of a reduced sympathetic and increased parasympathetic activity during dialysis. Further studies should investigate the prognostic value of HRV changes in dependency of ultrafiltration volume in patients on dialysis.
In
Out
p-value
AVNN (ms) **
836 [750,939]
819 [759,902]
<0.01
SDNN (ms) **
27.8 [21.4,39.2]
31.2 [24.2,42.3]
<0.01
RMSSD (ms) *
13.9 [9.35,22.9]
13.7 [10,20.3]
<0.05
pNN50 (%)
0.81 [0.19,4.87]
0.91 [0.25,3.97]
0.476
HRVIdx
6.88 [5.45,9.22]
7.03 [5.84,8.92]
0.920
TINN (ms)
102 [79,137]
104 [83.5,132]
0.713
LF (nu) **
68.8 [49.5,80.6]
70.6 [55.4,81.4]
<0.01
HF (nu) **
31.2 [19.4,50.5]
29.4 [18.6,44.6]
<0.01
LF/HF **
2.84 [1.31,5.63]
3.38 [2,6.58]
<0.01
Aix (%) **
26.9 [20.4,34.2]
28.5 [21.6,36.4]
<0.01
AIx75 (%) **
25.4 [20.3,31.6]
28.8 [22.9,33.6]
<0.01
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