BAROREFLEX SENSITIVITY AND HEMODYNAMIC RESPONSES DURING PHYSICAL AND MENTAL TESTS: A COMPARATIVE STUDY BETWEEN HEMODIALYSIS AND PERITONEAL DIALYSIS PATIENTS

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Objective: Cardiac arrhythmias and sudden death are the leading causes of mortality in end-stage kidney disease (ESKD) and autonomic dysfunction is considered to play a predominant role. This is the first study to compare baroreflex sensitivity (BRS) and hemodynamic responses after mental- and physical-stimulation maneuvers between hemodialysis (HD) and peritoneal (PD) patients. Design and method: 68 ESKD patients (34 HD and 34 PD patients matched for age, sex, and dialysis-vintage) were included. Continuous recordings from Finometer-PRO at rest and during mental-arithmetic, orthostatic, and handgrip-exercise tests were used for calculation of BRS and hemodynamic responses in each individual. Results: The two groups were similar in terms of age, sex, dialysis vintage and major comorbidities. BRS during mental (HD 3.59±2.62 vs PD 5.50±9.40 ms/mmHg, p=0.280) and physical stress tests (orthostatic: HD 3.23±2.42 vs PD 2.07±2.69 ms/mmHg, p=0.777) was similar between HD and PD patients. During mental test, both groups presented increases in SBP/DBP levels compared to rest (SBP HD: 156.3±27.7 vs 142.7±20.0mmHg, p<0.05; PD: 158.0±25.6 vs 143.1±23.6mmHg, p<0.05, respectively), but without significant between-group differences (p=0.853/p=0.611 respectively for SBP/DBP). Similarly, no significant between-group differences were noted in stroke volume, cardiac output, and total peripheral resistance during the same testing period. The mean SBP levels during the orthostatic test were significantly decreased compared to rest in both groups (HD: 135.4±26.8 vs 142.2 ±20.1 mmHg; p<0.05; PD 135.3±21.9 vs 143.1±23.6 mmHg; p<0.05), but the overall response was not different between-groups (p=0.937). Similarly, the responses to the other hemodynamic parameters were similar between HD and PD. Finally, the hemodynamic responses during handgrip exercise and recovery were not differed between HD and PD. Conclusions: BRS and hemodynamic responses to mental and physical stress tests were similar between HD and PD patients, suggesting that ANS function in ESKD is not affected by dialysis modality.

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