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

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Abstract

Background

The aim of this work was to measure the impact of active orthostatism and hemodialysis (HD) upon heart rate variability (HRV) in chronic renal failure (CRF) patients before and after HD.

Methods

Nineteen healthy subjects (age 27 ± 8 years old, 13 were female) and 19 unmedicated CRF patients with HD thrice per week (average HD vintage = 12 months, age 32 ± 9 years old, 11 were female) were included. Five-minute length HRV time series were obtained during supine position and orthostatism. Recordings from CRF patients were obtained before and after HD. Time domain and frequency domain HRV indexes were compared by analysis of variance. The correlation between each HRV index and change in sympathetic weighting induced by different maneuvers was tested by Kendall’s Tau correlation. A p value <0.05 was considered statistically significant.

Results

HRV indexes which are associated with sympathetic activity increased in response to orthostatism in the healthy group, e.g., low-frequency to high-frequency (LF/HF) ratio, Ln (LF/HF) = −0.3 ± 0.9 versus 0.9 ± 0.9. CRF patients before HD had higher sympathetic weighting than healthy participants, even in supine position, Ln (LF/HF) = 0.6 ± 1.0, but such a difference was accentuated during orthostatism, Ln (LF/HF) = 1.5 ± 1.0, and after HD: Ln (LF/HF) = 0.8 ± 1.3 (supine position) and 2.5 ± 2.1 (orthostatism). All HRV indexes were associated with increments in sympathetic weighting between maneuvers (Kendall´s correlations absolute values ≥0.24).

Conclusion

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.

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Acknowledgments

The authors thank CONACyT for financial support, Grant No. 169489. MVJ was financially supported by PAPIIT-IN107112, UNAM, México.

Conflict of interest

All the authors have no conflict of interest.

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Authors and Affiliations

  1. Departamento de Instrumentación Electromecánica, Instituto Nacional de Cardiología Ignacio Chávez, C. Juan Badiano No. 1 Col. Sección XVI. Tlalpan, CP 14080, Mexico, D.F., Mexico

    Claudia Lerma & Oscar Infante

  2. Laboratorio de Biofísica de Sistemas Excitables, Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico, D.F., Mexico

    Hortensia González

  3. Departamento de Nefrología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico, D.F., Mexico

    Hector Pérez-Grovas

  4. Theoretical Biology Group, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico, D.F., Mexico

    Marco V. José

Authors
  1. Claudia Lerma
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  2. Hortensia González
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  3. Hector Pérez-Grovas
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  4. Marco V. José
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  5. Oscar Infante
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Corresponding author

Correspondence to Oscar Infante.

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Lerma, C., González, H., Pérez-Grovas, H. et al. Preserved autonomic heart rate modulation in chronic renal failure patients in response to hemodialysis and orthostatism. Clin Exp Nephrol 19, 309–318 (2015). https://doi.org/10.1007/s10157-014-0990-1

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  • DOI: https://doi.org/10.1007/s10157-014-0990-1

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