Cardiovascular autonomic dysfunction in uremia

Robinson, Thompson G.; Carr, Sue

doi:10.1046/j.1523-1755.2002.00659.x

Cited by 82 publications

(69 citation statements)

References 76 publications

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“…16 Recently, the role of cardiovascular autonomic dysfunction has been emphasized as an independent risk factor for intradialytic hypotension or even sudden death in ESRD. 17,18 The spectral analysis of heart rate variability (HRV) has been proven to be a potent, noninvasive, sensitive, and reproducible tool for the diagnosis of cardiovascular autonomic dysfunction in ESRD. [19][20][21] It is well established that HRV can be divided into total power (TP, 0-0.5 Hz), high-frequency power (HF, 0.15-0.40 Hz), low-frequency power (LF, 0.04-0.15 Hz), and very-low-frequency power (VLF, 0.003-0.04 Hz) components.…”

Section: Introductionmentioning

confidence: 99%

The Subjective Sleep Quality and Heart Rate Variability in Hemodialysis Patients

Wei

Chung

et al. 2011

Renal Failure

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Introduction: Sleep disturbances and cardiovascular autonomic dysfunction are major complications of hemodialysis (HD). The goal of this study is to identify clinical, heart rate variability (HRV) or laboratory parameters that are independently associated with subjective sleep quality. Patient and methods: Forty-six stable HD patients filled out sleep questionnaires -Pittsburgh sleep quality index (PSQI), Athens insomnia scale (AIS), and Epworth sleepiness scale (ESS). In addition, they received analyses of 5-minute HRV twice, in lying posture before and after HD. We also recruited 50 healthy subjects who received 5-min HRV. Results: The patients with end-stage renal disease have a high rate of poor sleep quality according to PSQI, AIS, and ESS. The activities of total power (0-0.5 Hz), high-frequency power (HF, 0.15-0.40 Hz), low-frequency power (0.04-0.15 Hz), and very-low-frequency power (0.003-0.04 Hz) in HD patients are obviously lower than that in the healthy people. The poor sleepers (PSQI > 5) show lower heart rate, higher HF and variance before HD, but did not show a significant difference after HD. There is no significant difference between HRV and global score of AIS, but the insomnia group (AIS > 5) has higher BMI. These patients with sleepiness (ESS > 9) only reveal lower hemoglobin, although the global score of ESS reveals no significant relationship with HRV. Conclusion: HD patients have a high rate of poor sleep quality and autonomic dysfunction. Greater attention for the evaluation of sleep quality is needed for the better care of HD patients.

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Section: Introductionmentioning

confidence: 99%

The Subjective Sleep Quality and Heart Rate Variability in Hemodialysis Patients

Wei

Chung

et al. 2011

Renal Failure

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“…Heart rate responses to respiration have been employed for evaluating parasympathetic nervous system function in CKD populations (26). Röckel et al examined alteration of heart rate and blood pressure responses to the Valsalva maneuver in chronic renal failure and reported that 60% of them demonstrated abnormal heart rate responses to the maneuver (9).…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Autonomic Neuropathy Studied by a Laser-Doppler Blood Flowmeter in Hemodialysis Patients

et al. 2010

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Objective Orthostatic hypotension during a hemodialysis (HD) session affects not only the modality but daily quality of life for HD patients because many of them have combined dysfunction of both sympathetic and parasympathetic nervous systems. Although various non-invasive methods have been applied for the evaluation of autonomic function, no monitor has been devised for measuring the dysfunction during blood purification therapy. Patients and MethodsWe evaluated the usefulness of laser-Doppler blood flowmeter (LDF) for measuring autonomic function of stable 34 regular HD patients and 24 healthy controls. The LDF device was applied for autonomic test by measuring periflux blood flow decreasing velocity (PDV) accompanied with Valsalva maneuver. We also evaluated the correlation between PDV and conventional tests for atherosclerosis. Results The average PDV (3.79 ± 1.77) in HD population level was significantly lower than that of healthy controls (8.72 ± 6.00). We also found a significant correlation between PDV and conventional methods such as heart rate variability and ankle-brachial blood pressure index. Conclusion Measurement of PDV by LDF is as useful as a conventional method for evaluating autonomic function in HD patients. The convenience of the device offers the benefit of daily and frequent measurement of autonomic dysfunction.

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“…The VLF is thought to be influenced by thermoregulation of vasomotor tone; LF is affected by the baroreceptor reflex and is thought to reflect sympathetic and parasympathetic tone; HF is influenced by respiratory frequency and is thought to reflect parasympathetic tone. The LF/ HF ratio is an index of sympathovagal balance and thus of autonomic status (5,10,11).…”

Section: Methodsmentioning

confidence: 99%

“…34, No. 1 PDI of autonomic cardiovascular dysfunction under various clinical conditions (10)(11)(12)(13)(14), the most common finding has been decreased low-and high-frequency power of the decomposed spectrum of pulse interval variability, which are indices of sympathetic and parasympathetic activity respectively and have been associated with uremic neuropathy (5,(13)(14)(15). The magnitude of those changes is even more pronounced in diabetic patients because of concomitant diabetic neuropathy (16,17).…”

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confidence: 99%

“…udden cardiac death and arrhythmias are among the most frequent causes of cardiovascular mortality (1,2) in patients with end-stage renal disease (ESRD), in whom an imbalance between the sympathetic and parasympathetic nervous systems known as autonomic cardiovascular dysfunction may contribute to such complications (3)(4)(5)(6). Sympathetic overactivity, which is commonly found in skeletal muscle in patients with ESRD, is thought to play a role in the pathophysiology of the autonomic cardiovascular dysfunction usually found in ESRD (7).…”

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confidence: 99%

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Effect of Icodextrin on Heart Rate Variability in Diabetic Patients on Peritoneal Dialysis

et al. 2014

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♦ Introduction: Spectral analysis of heart rate variability is a noninvasive method for evaluating autonomic cardiovascular dysfunction under various clinical conditions, such as in dialysis patients, in whom an imbalance between the sympathetic and parasympathetic nervous system appears to be an important risk factor for sudden cardiovascular death and arrhythmia. ♦ Objective: We compared the effect of icodextrin-based dialysis solution, an option that allows for better metabolic and fluid overload control, with that of glucose-based dialysis fluid on sympathetic and parasympathetic activity in the heart, as assessed by heart rate variability, in diabetic patients on peritoneal dialysis (PD). ♦ Methods: This secondary analysis uses data from a randomized controlled trial in diabetic PD patients with high or high-average peritoneal transport using icodextrin-based (ICO group, n = 30) or glucose-based (GLU group, n = 29) solutions for the long dwell. All patients underwent 24-hour electrocardiographic Holter monitoring at baseline, and at 6 and 12 months of follow-up. ♦ Results: We observed no significant differences between the groups in most of the variables analyzed, although values were, in general, below reference values. In the ICO group, total power and both low-and high-frequency power in normalized units increased, but the percentage of RR intervals with variation of more than 50 ms declined over time; in the GLU group, all those values declined. Plasma catecholamine levels were higher at baseline and declined over time. ♦ Conclusions: These results indicate a partial recovery of sympathetic activity in the ICO group, probably because of better extracellular fluid control and lower exposure to glucose with the use of icodextrin-based dialysis solutions.

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Cardiovascular autonomic dysfunction in uremia

Cited by 82 publications

References 76 publications

The Subjective Sleep Quality and Heart Rate Variability in Hemodialysis Patients

The Subjective Sleep Quality and Heart Rate Variability in Hemodialysis Patients

Cardiovascular Autonomic Neuropathy Studied by a Laser-Doppler Blood Flowmeter in Hemodialysis Patients

Effect of Icodextrin on Heart Rate Variability in Diabetic Patients on Peritoneal Dialysis

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