Predictors of haemodynamic instability and heart rate variability during haemodialysis

Rubinger, Dvora; Revis, Nina; Pollak, Arthur; Luria, Myron H.; Sapoznikov, Dan

doi:10.1093/ndt/gfh306

Cited by 100 publications

(97 citation statements)

References 15 publications

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“…Our results suggest that a low value of LF/HF of HRV may indicate a decreased capacity for activating sympathetically mediated HR and vasoconstriction mechanisms in response to hypotension, thus predisposing to the development of PRS following reperfusion. These results are in agreement with the result of previous studies showing that hypotension episodes during hemodialysis are significantly associated with decreased LF/HF [13,31]. Although altered cardiovascular autonomic control may not provide the entire explanation for the occurrence of graft reperfusion-related hypotension during liver transplantation surgery, the evaluation of HRV indices, including LF/HF appears to be particularly helpful in predicting PRS occurrence.…”

Section: Discussionsupporting

confidence: 91%

“…These observations suggest that there is a relationship between cardiovascular autonomic control and hemodynamic stability during liver transplantation surgery. Furthermore, cardiovascular autonomic indices derived from power spectral analysis, such as the ratio of low frequency power to high frequency power (LF/HF) or the total power of heart rate variability (HRV), have attracted attention with regard to their potential use in predicting hypotensive episodes in patients undergoing anesthesia or hemodialysis [13][14][15]. However, the association between cardiovascular autonomic indices and reperfusion-related hemodynamic instability during liver transplantation remains to be established.…”

Section: Introductionmentioning

confidence: 99%

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Sympathetic withdrawal is associated with hypotension after hepatic reperfusion

et al. 2013

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Objective Post-reperfusion syndrome (PRS), severe hypotension after graft reperfusion during liver transplantation, is an adverse clinical event associated with poorer patient outcomes. The purpose of this study was to determine whether alterations in autonomic control in liver transplant recipients prior to graft reperfusion are associated with the subsequent development of PRS. Methods Heart rate variability (HRV), systolic arterial blood pressure (SBP) variability, and baroreflex sensitivity of 218 liver transplant recipients were evaluated using 5 min of ECG and arterial blood pressure signals 10 min before graft reperfusion along with other clinical parameters. Logistic regression analyses were performed to assess predictors of PRS occurrence. Results Seventy-seven patients (35 %) developed PRS while 141 did not. There were significant differences in SBP (110 ± 16 vs. 119 ± 16 mmHg, P \ 0.001) and the ratio of low frequency power to high frequency power (LF/ HF) of HRV (1.0 ± 1.4 vs. 2.1 ± 3.7, P = 0.003) between the PRS group and No-PRS group. In multivariate logistic regression analysis, predictors were LF/HF (odds ratio 0.817, P = 0.028) and SBP (odds ratio 0.966, P \ 0.001).Interpretation Low LF/HF and SBP measured before hepatic graft reperfusion were significantly correlated with subsequent PRS occurrence, suggesting that sympathovagal imbalance and depressed SBP may be key factors predisposing to reperfusion-related severe hypotension in liver transplant recipients.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Sympathetic withdrawal is associated with hypotension after hepatic reperfusion

et al. 2013

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“…Because 24-hour SDNN is substantially contributed by the day-night difference in heart rate (6), it could be influenced by hemodialysis session. In addition, SDNN is known to decrease with hemodialysis itself, particularly when the hemodialysis involves hemodynamic instability (25).…”

Section: Discussionmentioning

confidence: 99%

Nonlinear Measures of Heart Rate Variability and Mortality Risk in Hemodialysis Patients

Suzuki

Aoyama

Tanaka

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Nonlinear measures of heart rate variability (HRV) have gained recent interest as powerful risk predictors in various clinical settings. This study examined whether they improve risk stratification in hemodialysis patients.Design, setting, participants, & measurements To assess heart rate turbulence, deceleration capacity, fractal scaling exponent (a 1 ), and other conventional HRV measures, 281 hemodialysis patients underwent 24-hour electrocardiography between January 2002 and May 2004 and were subsequently followed up.Results During a median 87-month follow-up, 77 patients (27%) died. Age, left ventricular ejection fraction, serum albumin, C-reactive protein, and calcium 3 phosphate independently predicted mortality. Whereas all nonlinear HRV measures predicted mortality, only decreased scaling exponent a 1 remained significant after adjusting for clinical risk factors (hazard ratio per a 0.25 decrement, 1.46; 95% confidence interval [95% CI], 1.16-1.85). The inclusion of a 1 into a prediction model composed of clinical risk factors increased the C statistic from 0.84 to 0.87 (P=0.03), with 50.8% (95% CI, 20.2-83.7) continuous net reclassification improvement for 5-year mortality. The predictive power of a 1 showed an interaction with age (P=0.02) and was particularly strong in patients aged ,70 years (n=208; hazard ratio, 1.87; 95% CI, 1.38-2.53), among whom a 1 increased the C statistic from 0.85 to 0.89 (P=0.01), with a 93.1% (95% CI, 59.3-142.0) continuous net reclassification improvement.Conclusions Scaling exponent a 1 that reflects fractal organization of short-term HRV improves risk stratification for mortality when added to the prediction model by conventional risk factors in hemodialysis patients, particularly those aged ,70 years.

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“…In addition, given that CMRI was used to determine our cohort's LVM, it is reasonable to assume that our assessment of LVM was less likely to be confounded by various measurement errors such as excess extracellular fluid volume, a problem known to plague echocardiogram-derived estimates of LVM. Studies of HRV and ESRD have consistently shown a decrement in HRV (2,20,21). Reduced HRV has been established as an independent risk factor in patients with high cardiac risk profile (22), which was exemplified by The Autonomic Tone and Reflexes After Myocardial Infarction (3) trial.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Cardiac Autonomic Dysfunction in ESRD

Chan¹,

Levin²,

Chertow³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Cardiovascular events are common in patients with ESRD. Whether sympathetic overactivity or vagal withdrawal contribute to cardiovascular events is unclear. We determined the general prevalence and clinical correlates of heart rate variability in patients on hemodialysis.Design Conclusions: Holter findings in patients on hemodialysis are characterized by sympathetic overactivity and vagal withdrawal and are associated with higher LVM and impaired physical performance. Understanding the spectrum of autonomic heart rate modulation and its determinants could help to guide preventive and therapeutic strategies.

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Predictors of haemodynamic instability and heart rate variability during haemodialysis

Cited by 100 publications

References 15 publications

Sympathetic withdrawal is associated with hypotension after hepatic reperfusion

Sympathetic withdrawal is associated with hypotension after hepatic reperfusion

Nonlinear Measures of Heart Rate Variability and Mortality Risk in Hemodialysis Patients

Determinants of Cardiac Autonomic Dysfunction in ESRD

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