HEMODIALYSIS SESSION EFFECTS ON AUTONOMIC NERVOUS SYSTEM FUNCTION: HEMODYNAMIC RESPONSES AND BAROREFLEX SENSITIVITY

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Objective: Cardiac arrhythmias are the first cause of death in hemodialysis patients and autonomic dysfunction possesses a predominant role in the arrhythmogenic substrate of these patients. This is the first study comparing baroreflex sensitivity (BRS) and hemodynamic responses at rest and after mental- and physical-stimulation maneuvers at multiple timepoints around and during the dialysis session. Design and method: 36 hemodialysis patients underwent continuous measurements of beat-to-beat blood pressure (BP) and heart rate (HR) with Finometer-PRO. Recordings at rest and during mental arithmetic, orthostatic, and handgrip exercise tests were used for calculation of BRS and hemodynamic responses in each individual. Results: BRS did not differ significantly when assessed at different timepoints around hemodialysis and as a response to mental and physical stress tests. Regarding hemodynamic parameters, during mental stress, systolic (SBP, 149.2±29.8 vs157.2±27.3mmHg, p=0.035), diastolic BP (DBP, 70.2±18.3 vs 79.8±13.2mmHg, p=0.001), mean arterial pressure and HR were significantly higher at mid-dialysis compared to the non-dialysis day. During the orthostatic test, SBP (137.4±25.7 vs 128.6±32.5mmHg, p=0.031), stroke volume and cardiac output were significantly reduced, and HR significantly increased post-dialysis (80.9±13.4 vs 87.5±16.8bpm, p<0.001). During the handgrip test, no differences in SBP/DBP levels were evident in pre- versus post-dialysis, while HR was higher in post-dialysis measurements (81.6±13.3 vs 86.7±15.3bpm, p=0.002). Conclusions: Dialysis session per se provokes significant changes in hemodynamic responses after stimulation with multiple physiological test maneuvers but did not affect BRS. This hemodialysis-provoked autonomic dysregulation could in part explain the increased cardiovascular risk of these patients.

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