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Heart rate variability is an indicator for intradialytic hypotension among chronic hemodialysis patients

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Abstract

Background

Intradialytic hypotension (IDH) carries adverse impact. Heart rate variability (HRV) represents autonomic cardiac regulation which influences intradialytic blood pressure. We aimed to evaluate the association between IDH and HRV.

Methods

This prospective study was carried out in a teaching hospital in Taiwan from June to August 2010. Adult patients on chronic hemodialysis without active medical conditions were enrolled and received HRV measurements for 4 times (before and during an index hemodialysis session). Patients were categorized by the changes of systolic blood pressure during the index hemodialysis into Group 1 (elevation >20 mmHg), Group 2 (decrease >20 mmHg), and Group 3 (others). Then we compared HRV indices among the three groups, and determined the indicators for IDH.

Results

One hundred and seventy-one patients (96 women, mean age 64.9 years) were enrolled and categorized into Group 1 (n = 47, 27.5 %), Group 2 (n = 45, 26.3 %) and Group 3 (n = 79, 46.2 %). Comparing with Group 1 and/or Group 3, Group 2 had significantly higher blood pressure at hemodialysis initiation (most p < 0.001) and statistically lower levels of HRV indices including variance, total power, very low-frequency, low-frequency and high-frequency since the middle phase of the hemodialysis. By logistic regression method, higher systemic blood pressure [odds ratio (OR) 1.048; p < 0.001], heart rate (OR 1.093; p = 0.021), low-frequency/high-frequency ratio (OR 1.715; p = 0.022), as well as lower variance (OR 0.639; p = 0.048) at hemodialysis initiation were independently associated with intradialytic blood pressure changes.

Conclusions

HRV is a useful indicator for IDH among hemodialysis patients.

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Abbreviations

Gp:

Group

HF:

High frequency

HRV:

Heart rate variability

LF:

Low frequency

TP:

Total power

Var:

Variance of the R–R interval values

VLF:

Very low frequency

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Acknowledgments

The authors thank staffs in the hemodialysis center of Saint Mary’s Hospital Luodong who performed the measurement of HRV. The research was supported by Saint Mary’s Hospital Research Fund (SMHRF-2010004).

The SMCKD (Saint Mary’s hospital Chronic Kidney Disease) study group includes Chih-Chung Shiao, MD; Yu-Ming Chang, MD; Jsun-Liang Kao, MD; Shih-Ching Tsai, MD; Rong-Na Jhen, MD; Chuan-Lan Yang, RN; Shu-Min Huang, RN; Ching-Hua Huang, RN; Yu-**g Wu, RN; Huei-Ru Chin, RN; I-Ling Chen, RN; Kuai-Sui Hsu, RN; Show-Chin Leu, RN, Hung-Li Su, RN; Mei-Yun Kao, RN.

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Author notes

    Authors and Affiliations

    1. Division of Nephrology, Department of Internal Medicine, Saint Mary’s Hospital Luodong, Yilan, Taiwan

      Yu-Ming Chang, Chih-Chung Shiao, Jsun-Liang Kao, Shih-Ching Tsai & Rong-Na Jhen

    2. Department of Nursing, Saint Mary’s Hospital Luodong, Yilan, Taiwan

      I-Ling Chen, Chuan-Lan Yang, Show-Chin Leu & Hung-Li Su

    3. Saint Mary’s Medicine, Nursing and Management College, Yilan, Taiwan

      Chih-Chung Shiao

    4. Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan

      Kuo-Chi Chang

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    1. Yu-Ming Chang
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    Correspondence to Chih-Chung Shiao.

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    The authors have declared that no conflict of interest exists.

    Additional information

    On behalf of SMCKD (Saint Mary’s hospital Chronic Kidney Disease) study group.

    Members of the Saint Mary’s hospital Chronic Kidney Disease study group are given in Acknowledgments.

    Y.-M. Chang, C.-C. Shiao and K.-C. Chang have contributed equally to this work.

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    Chang, YM., Shiao, CC., Chang, KC. et al. Heart rate variability is an indicator for intradialytic hypotension among chronic hemodialysis patients. Clin Exp Nephrol 20, 650–659 (2016). https://doi.org/10.1007/s10157-015-1189-9

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    • DOI: https://doi.org/10.1007/s10157-015-1189-9

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