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Sci Rep. 2019 Dec 11;9(1):18783. doi: 10.1038/s41598-019-55001-4.

Alteration autonomic control of cardiac function during hemodialysis predict cardiovascular outcomes in end stage renal disease patients.

Kao CC1,2,3, Tseng CH4,5, Lo MT4,6, Lin YK4,7, Hsu CY8,9,10, Wu YL1,2,3, Chen HH1,2, Lin FY9,10, Lin C11,12, Huang CY13,14.

Author information

1
Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
2
Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
3
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
4
Department of Biomedical Sciences and Engineering, National Central University, Taoyuan city, Taiwan.
5
Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.
6
Center for Biotechnology and Biomedical Engineering, National Central University, Taoyuan city, Taiwan.
7
Division of Nephrology, Department of Medicine, Landseed International Hospital, Taoyuan city, Taiwan.
8
Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.
9
Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.
10
Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
11
Department of Biomedical Sciences and Engineering, National Central University, Taoyuan city, Taiwan. dreamtheater.lin@gmail.com.
12
Center for Biotechnology and Biomedical Engineering, National Central University, Taoyuan city, Taiwan. dreamtheater.lin@gmail.com.
13
Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan. cyhuang@tmu.edu.tw.
14
Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan. cyhuang@tmu.edu.tw.

Abstract

Dialysis-induced hemodynamic instability has been associated with increased risk of cardiovascular (CV) mortality. However, the control mechanisms beneath the dynamic BP changes and cardiac function during hemodialysis and subsequent CV events are not known. We hypothesize that the impaired hemodynamic control can be prognostic indicators for subsequent CV events in end stage renal diseaes (ESRD) patients. To explore the association of hemodynamic parameters and CV events in hemodialysis patients, we enrolled ESRD patients who received chronic hemodialysis without documented atherosclerotic cardiovascular disease and hemodynamic parameters were continuously obtained from the impedance cardiography during hemodialysis. A total of 35 patients were enrolled. 16 patients developed hospitalized CV events. The statistical properties [coefficient of variance (standard deviation / mean value; CoV)] of hourly beat-to-beat dynamics of hemodynamic parameters were calculated. The CoV of stroke volume (SV) and cardiac index (CI) between the 1st and 2nd hour of dialysis were significantly increased in patients without CV events compared to those with CV events. Higher CoV of SVdiff and CIdiff were significantly correlated with longer CV event-free survival, and the area under the receiver operating characteristic (ROC) curve showed fair overall discriminative power (0.783 and 0.796, respectively). The responses of hemodynamic control mechanisms can be independent predictive indexes for lower hospitalized CV events, which implies that these patients who have better autonomic control systems may have better CV outcomes.

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