Abstract: SA-PO889
Intradialytic Hemodynamics and Autonomic Activity in Patients Without and with Blood Pressure Instability
Session Information
- Dialysis: Cardiovascular, BP, Volume
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Rubinger, Dvora, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Dranitzki Elhalel, Michal, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Sapoznikov, Dan, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Background
The present study was undertaken to assess the intradialytic hemodynamics and autonomic activity in patients (pts.) without (stable) and with frequent hypotensive episodes (unstable).
Methods
Beat-to-beat systolic blood pressure (SBP) and interbeat intervals (IBI) were monitored using Finometer during a single constant blood flow hemodialysis (HD) session in 14 unstable and 18 age-matched stable chronic non-diabetic HD pts. Stroke volume (SV) ,cardiac output (CO) and total peripheral resistance (TPR) were calculated using Modelflow simulation. LF/HF (the ratio of average IBI powers in the low (LF) and high (HF) frequency ranges) was considered to represent sympatho-vagal balance, whereas LF α (the ratio of IBI and SBP powers in the LF range) was considered to represent sympathetic activity. Positive correlation between IBI and SBP was considered representative of baroreflex (Baro) activity. Repeated measures ANOVA was performed to assess time variations in both groups. Mixed design ANOVA was performed to assess differences in time variations between groups.
Results
During HD, SBP remained constant in both groups and there were no episodes of symptomatic hypotension. Comparable decreases in SV, CO and an increase in TPR were noted in all pts. LFα increased during HD in both stable and unstable groups. LF/HF increased in unstable and decreased in stable pts. Baro activity was predominant in the stable pts, in whom it consistently increased during HD, while in unstable pts. an increase in Baro activity was noted only at the beginning of dialysis ( Figure 1).
Conclusion
Our data show that similar hemodynamic changes in stable and unstable pts are mediated by slightly different mechanisms. During HD, the sympatho-vagal balance is attenuated in stable and enhanced in unstable pts.SBP in stable seems to be predominantly controlled by Baro , while in unstable pts. SBP is controlled by both Baro and non-Baro mechanisms.
Figure 1.