Key result
In hemodialysis patients, heart rate variability parameters significantly increased after hemodialysis in those without peripheral artery disease (HF P=0.013, LF% P=0.028, LF/HF P=0.034), whereas no significant changes occurred in patients with peripheral artery disease.
Why the study?
Does the presence of peripheral artery disease affect heart rate variability changes during hemodialysis in maintenance hemodialysis patients?
Cross-Sectional (n=161)
No
Does the presence of peripheral artery disease affect heart rate variability changes during hemodialysis in maintenance hemodialysis patients?
Hemodialysis patients with peripheral artery disease fail to show the normal compensatory increase in heart rate variability after dialysis, reflecting an impaired sympatho-vagal equilibrium.
PAD may blunt post-dialysis autonomic recovery in hemodialysis patients; hypothesis-generating and should not yet change practice.
Peripheral artery disease (PAD) and low heart rate variability (HRV) are highly prevalent in hemodialysis patients, and both are associated with increased cardiovascular morbidity and mortality. This study aims to examine the suggested relationship between PAD and HRV, and the relationship of parameters before and after hemodialysis. This study enrolled 161 maintenance hemodialysis patients. PAD was defined as ABI < 0.9 in either leg. HRV was performed to assess changes before and after hemodialysis. The change in HRV (△HRV) was defined as post-hemodialysis HRV minus pre-hemodialysis HRV. Patients' clinical parameters were collected from the dialysis records. All HRV parameters except high frequency (HF) % were lower in patients with PAD than patients without PAD, though not achieving significant level. In patients without PAD, HF (P = 0.013), low frequency (LF) % (P = 0.028) and LF/HF (P = 0.034) were significantly elevated after hemodialysis, whereas no significant HRV parameters change was noted in patients with PAD. Serum intact parathyroid hormone was independently associated with △HF (β = -0.970, P = 0.032) and △LF% (β = -12.609, P = 0.049). Uric acid level (β = -0.154, P = 0.027) was negatively associated with △LF/HF in patients without PAD. Our results demonstrated that some of the HRV parameters were significantly increased after hemodialysis in patients without PAD, but not in patients with PAD, reflecting a state of impaired sympatho-vagal equilibrium. Severity of secondary hyperparathyroidism and hyperuricemia contributed to lesser HRV parameters increase after hemodialysis in patients without PAD.
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Chen et al. (2015) conducted a cross-sectional in End-stage renal disease on maintenance hemodialysis (n=161). Peripheral Artery Disease (PAD) vs. Patients without PAD was evaluated on Change in heart rate variability (HRV) parameters (HF, LF%, LF/HF) before and after hemodialysis. In hemodialysis patients, heart rate variability parameters significantly increased after hemodialysis in those without peripheral artery disease (HF P=0.013, LF% P=0.028, LF/HF P=0.034), whereas no significant changes occurred in patients with peripheral artery disease.
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