Abstract
Background
Few studies have focused on the imbalance of the autonomic nervous system in ultrafiltration rate (UFR) subjects without blood pressure variation during maintenance hemodialysis (HD), although the role of autonomic nervous system activation during HD has been proposed to be an important factor for the maintenance of blood pressure.
Methods
Variations over time in autonomic nervous activity due to differences in UFR were evaluated by measuring heart rate variability (HRV) and approximate entropy (ApEn) in 35 HD patients without blood pressure variations during HD session. The subjects were divided into 3 groups, those with UFR <10 ml/h/kg; ≥10 ml/h/kg but ≤15 ml/h/kg; and >15 ml/h/kg, and Holter ECG was recorded continuously during HD session using frequency analysis of RR intervals. High frequency (HF) and low frequency (LF) spectral components are found to be representative of the parasympathetic nervous system and sympathovagal balance, respectively, with the ratio of LF to HF of HRV providing a measure of sympathetic nervous system.
Results
In subjects with UFR >15 ml/h/kg, HF components were significantly lower, and LF/HF and ApEn values were significantly higher, in the latter half of an HD session than before starting HD.
Conclusion
Removing water from these subjects would promote sustained sympathetic nervous overactivity. These findings indicate that the UFR during HD needs to be set at ≤15 ml/h/kg.
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Acknowledgments
The authors thank the staff of the dialysis center at Yodogawa Christian Hospital for their help with data collection.
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All authors declare no competing financial interests.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional, and national research committee at which the studies were conducted (IRB approval number NCT02754986) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Tsuji, Y., Suzuki, N., Hitomi, Y. et al. Quantification of autonomic nervous activity by heart rate variability and approximate entropy in high ultrafiltration rate during hemodialysis. Clin Exp Nephrol 21, 524–530 (2017). https://doi.org/10.1007/s10157-016-1305-5
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DOI: https://doi.org/10.1007/s10157-016-1305-5