Preserved autonomic heart rate modulation in chronic renal failure patients in response to hemodialysis and orthostatism

Lerma, Claudia; González, Hortensia; Pérez-Grovas, Héctor; José, Marco V.; Infante, Oscar

doi:10.1007/s10157-014-0990-1

Cited by 15 publications

(25 citation statements)

References 33 publications

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“…ECG recordings were obtained with a protocol described previously . Briefly, a continuous ECG recording (lead II) was obtained during 16 min in supine position, and a subsequent recording was also collected during 16 min of active orthostatism.…”

Section: Methodsmentioning

confidence: 99%

“…The aim of this work was to evaluate α 1 of CRF patients from 5‐min recordings to identify the effect of orthostatism and HD, and to evaluate the correlation between α 1 and the mean RR intervals from sinus beats (meanNN) for these patients. Following a previous study , we hypothesized that changes of the scaling exponent driven by an orthostatic challenge in CRF patients with stable blood pressure, either before or after HD, are similar to those shown by healthy subjects once considering the actual differences in meanNN between groups.…”

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confidence: 99%

“…Persistent sympathetic overactivity, as evidenced by the analysis of heart rate variability (HRV), is common for CRF patients . In many patients, the linear HRV indexes indicate accelerated heart rate (i.e., shorter mean RR intervals or meanNN), reduced parasympathetic influence towards the heart (e.g., reduced root‐mean‐squared of successive differences [RMSSD] or reduced spectral power within the high frequency band [HF]), and increased preponderance of sympathetic activity (e.g., increased low frequency band [LF] and LF/HF indexes) . Although sympathetic overactivity increases the long‐term risk of mortality, sustained sympathetic predominance becomes important to prevent hypotension during HD and it is also linked to major cardiovascular adaptations associated to blood pressure stability in CRF (i.e., accelerated heart rate, increased peripheral resistance, increased baroreflex delay and reduced baroreflex sensivity) .…”

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confidence: 99%

“…All these adaptations have been considered as evidence that the cardiovascular mechanisms, such as the baroreflex control, are operating by a regulatory set point shifted towards a state of “saturation” . However, this adjustment does not imply the loss of a regulatory capacity for some CRF patients because they still exhibit a clear response to external stimulus such as orthostatism and hemodialysis , and because following a renal transplant several cardiovascular abnormalities may be reversed .…”

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confidence: 99%

“…Thus, the influence of mean heart rate upon the diagnostic and prognostic value of linear HRV indexes should be taken into consideration . As a consequence, some changes in the linear HRV indexes of CRF patients (either due to renal disease or as a response to stimulus such as orthostatism and HD) could be then basically explained by variations in the mean heart rate associated to a shifted operating setting points of cardiovascular control mechanisms.…”

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confidence: 99%

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Effects of Orthostatism and Hemodialysis on Mean Heart Period and Fractal Heart Rate Properties of Chronic Renal Failure Patients

Infante¹,

Pérez-Grovas²,

González

et al. 2017

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The aim of this work was to evaluate the short-term fractal index (α ) of heart rate variability (HRV) in chronic renal failure (CRF) patients by identifying the effects of orthostatism and hemodialysis (HD), and by evaluating the correlation between α and the mean RR interval from sinus beats (meanNN). HRV time series were derived from ECG data of 19 CRF patients and 20 age-matched healthy subjects obtained at supine and orthostatic positions (lasting 5 min each). Data from CRF patients were collected before and after HD. α was calculated from each time series and compared by analysis of variance. Pearson's correlations between meanNN and α were calculated using the data from both positions by considering three groups: healthy subjects, CRF before HD and CRF after HD. At supine position, α of CRF patients after HD (1.17 ± 0.30) was larger (P < 0.05) than in healthy subjects (0.89 ± 0.28) but not before HD (1.10 ± 0.34). α increased (P < 0.05) in response to orthostatism in healthy subjects (1.29 ± 0.26) and CRF patients after HD (1.34 ± 0.31), but not before HD (1.25 ± 0.37). Whereas α was correlated (P < 0.05) with the meanNN of healthy subjects (r = -0.562) and CRF patients after HD (r = -0.388), no significance in CRF patients before HD was identified (r = 0.003). Multiple regression analysis confirmed that α was mainly predicted by the orthostatic position (in all groups) and meanNN (healthy subjects and patients after HD), showing no association with the renal disease condition in itself. In conclusion, as in healthy subjects, α of CRF patients correlates with meanNN after HD (indicating a more irregular-like HRV behavior at slower heart rates). This suggests that CRF patients with stable blood pressure preserve a regulatory adaptability despite a shifted setting point of the heart period (i.e., higher heart rate) in comparison with healthy subjects.

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Section: Methodsmentioning

confidence: 99%

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Effects of Orthostatism and Hemodialysis on Mean Heart Period and Fractal Heart Rate Properties of Chronic Renal Failure Patients

Infante¹,

Pérez-Grovas²,

González

et al. 2017

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Continuous wavelet transform based processing for estimating the power spectrum content of heart rate variability during hemodiafiltration

Cartas-Rosado

Becerra-Luna

Martínez-Memije

et al. 2020

Biomedical Signal Processing and Control

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Sign and magnitude scaling properties of heart rate variability in patients with end-stage renal failure: Are these properties useful to identify pathophysiological adaptations?

Lerma

Infante

Pérez-Grovas

et al. 2017

Chaos: An Interdisciplinary Journal of Nonlinear Science

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The scaling properties of heart rate variability data are reliable dynamical features to predict mortality and for the assessment of cardiovascular risk. The aim of this manuscript was to determine if the scaling properties, as provided by the sign and magnitude analysis, can be used to differentiate between pathological changes and those adaptations basically introduced by modifications of the mean heart rate in distinct manoeuvres (active standing or hemodialysis treatment, HD), as well as clinical conditions (end stage renal disease, ESRD). We found that in response to active standing, the short-term scaling index (α) increased in healthy subjects and in ESRD patients only after HD. The sign short-term scaling exponent (α) increased in healthy subjects and ESRD patients, showing a less anticorrelated behavior in active standing. Both α and α did show covariance with the mean heart rate in healthy subjects, while in ESRD patients, this covariance was observed only after HD. A reliable estimation of the magnitude short-term scaling exponent (α) required the analysis of time series with a large number of samples (>3000 data points). This exponent was similar for both groups and conditions and did not show covariance with the mean heart rate. A surrogate analysis confirmed the presence of multifractal properties (α > 0.5) in the time series of healthy subjects and ESDR patients. In conclusion, α and α provided insights into the physiological adaptations during active standing, which revealed a transitory impairment before HD in ESRD patients. The presence of multifractal properties indicated that a reduced short-term variability does not necessarily imply a declined regulatory complexity in these patients.

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Preserved autonomic heart rate modulation in chronic renal failure patients in response to hemodialysis and orthostatism

Abstract: Unmedicated young CRF patients treated with hemodynamically stable maintenance HD showed preserved capacity of autonomic response (with gradual sympathetic increases) induced by cardiovascular challenges such as orthostatism and HD.

Cited by 15 publications

References 33 publications

Effects of Orthostatism and Hemodialysis on Mean Heart Period and Fractal Heart Rate Properties of Chronic Renal Failure Patients

Effects of Orthostatism and Hemodialysis on Mean Heart Period and Fractal Heart Rate Properties of Chronic Renal Failure Patients

Continuous wavelet transform based processing for estimating the power spectrum content of heart rate variability during hemodiafiltration

Sign and magnitude scaling properties of heart rate variability in patients with end-stage renal failure: Are these properties useful to identify pathophysiological adaptations?

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