Cardiac autonomic dysfunction predicts poor peritoneal dialysis technique survival
| Main Authors: | Natalia Stepanova, Olena Burdeyna, Lyudmila Snisar |
|---|---|
| Format: | Proceeding Journal |
| Bahasa: | eng |
| Terbitan: |
, 2019
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| Subjects: | |
| Online Access: |
https://zenodo.org/record/3344792 |
Daftar Isi:
- INTRODUCTION: The relationship problem of cardiac autonomic dysfunction in peritoneal dialysis (PD) patients to dialysis adequacy and technique survival has never been investigated before. METHODS: In this cross-sectional study, the associations between heart rate variability (HRV) measures and the indicators of dialysis adequacy in 44 PD patients (average age 50.8±12.5) were analysed. HRV was measured by using 5-min recordings of a stationary system by a standardized method. Both temporal domain and spectral domain parameters were analysed. The dialysis adequacy indices were evaluated taking into account weekly creatinine clearance (CrCl) and total weekly urea clearance (Kt/V). All the statistical analyses were performed using MedCalc. RESULTS: A significantly higher activity of the sympathetic cardiac activity was observed in the patients with inadequate dialysis dose (Kt/V<1.7), as evidenced by a decrease in SDNN (53.5 [28.5-73] vs 121 [72-195] p = 0.001).The parasympathetic activity of both temporal (RMSSD, CV) and spectral parameters of HRV (HF) had a moderate negative correlation with the PD adequacy (r = -0.43, p = 0.008; r = -0.36, p = 0.006 and r = -0.37, p = 0.005, according to the indicators). The spectral domain parameter LF, which reflected the relative vasomotor centre activity, had a direct correlation with CrCl (r = 0.53, p = 0.008). The coefficient of variation (CV) had a direct correlation with the status of residual renal function (r = 0.53; p < 0.0001). The preservation of dialysis adequacy was significantly dependent on the sympathetic activity (VLF and CV). The increase of 30% or more for VLF demonstrated the technique survival as 21.8 ± 2 (95% CI 17.8-25.9) months, while the technique survival in the patients with normal sympathetic activity (VLF<30%) was 46.5 ± 5.2 (95% CI 36.4-56.6) months (p = 0.0001). CONCLUSIONS: Our study has demonstrated the relationship of cardiac autonomic dysfunction with the PD adequacy. We suggest that the reduction in sympathetic hyperactivity can improve the PD adequacy and technique survival.