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

Abstract

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.

Physical Exercise Affects Quality of Life and Cardiac Autonomic Modulation in Patients With Chronic Kidney Failure Submitted to Hemodialysis: A Randomized Clinical Trial

“…According to prior literature (Agarwal, 2008; Bauer et al, 2008), practicing physical exercise reduces the risks of adverse cardiac events by modifying the autonomic balance and improving the sympathovagal balance. The improvement in cardiovascular capacity has significant effects, in turn, on patients’ cardiac autonomic modulation during hemodialysis, since physical practice causes an increase in the time and frequency domains of heart rate variability (Alvarez-Ramirez et al, 2017; Drawz, et al, 2013; Okano, et al, 2010). One prior protocol demonstrated a reduction in cardiovascular episodes associated with structural impairment of vessels or damage to the autonomic nervous system due to the action of uremic toxins with an associated increase in the SDNN, RMSD parameters (Chung et al, 2017).…”

Ultrasound validation of Trendelenburg positioning to increase internal jugular vein cross-sectional area in chronic dialysis patients

“…All of the patients were positioned with their neck in extension and head rotated left at [20][21][22][23][24][25][26][27][28][29][30] . Patients were studied in State 0, table flat (no tilt), with the patients in the supine position, and State T, in which the operating table was tilted 15 to a TP.…”

“…2,[23][24][25] Anemia, left ventricular hypertrophy, diastolic dysfunction and vascular dysfunction are all the characteristic manifestations in dialysis patients. An increasing number of older dialysis patients with diabetes mellitus and autonomic neuropathy caused by uremic poisoning of the baroreceptors [25][26][27] may stimulates morbidity of autonomic disorder in dialysis patients. Stimulation of the sympathetic nervous system seems to be the mechanism that is likely to cause cardiovascular complications, including sudden cardiac death, in chronically dialyzed patients.…”

“…10 Therefore, excessive left rotation should be avoided to minimize the risk of unintentional CA puncture during right IJV cannulation. In the present study, each patient's head was positioned with the head rotated left at [20][21][22][23][24][25][26][27][28][29][30] . According to our review of the literature, the effects of TP on the overlap between the CA and the IJV have not yet been evaluated.…”

Study of time reversibility/irreversibility of cardiovascular data: theoretical results and application to laser Doppler flowmetry and heart rate variability signals

“…The first moment of the photocurrent power spectrum gives the LDF signal that reflects the microvascular perfusion. LDF data are now commonly used in clinical research to monitor microvascular blood flow and are the subject of many papers (see for example Bernjak et al 2011, Tew et al 2011, Wojtkiewicz et al 2011, Binzoni et al 2010, Okano et al 2010, Al-Tahami et al 2010.…”