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, 9 (1), 18783

Alteration Autonomic Control of Cardiac Function During Hemodialysis Predict Cardiovascular Outcomes in End Stage Renal Disease Patients

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Alteration Autonomic Control of Cardiac Function During Hemodialysis Predict Cardiovascular Outcomes in End Stage Renal Disease Patients

Chih-Chin Kao et al. Sci Rep.

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.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow chart of the study.
Figure 2
Figure 2
Temporal changes of coefficient variance of (a) stroke volume (SV) and (b) cardiac index (CI) during dialysis between groups.
Figure 3
Figure 3
Survival analysis of CV events according to the optimal dichotomized threshold of differences of coefficient variance of (a) SV between 2nd and 1st hr of dialysis (SVdiff) and (b) CI between 2nd and 1st hr of dialysis (CIdiff).
Figure 4
Figure 4
Receiver operating characteristic curves for the differences of coefficient variance of SV between 2nd and 1st hr of dialysis (SVdiff; solid line), CI between 2nd and 1st hr of dialysis (CIdiff; dotted line) and the multivariable generalized linear model with binomial distribution on the combination of SVdiff and CIdiff (gray dashed line) and combination of SVdiff, CIdiff, and DM (gray dash-dotted line). Abbreviations: CI: cardiac index, DM: diabetes mellitus, SV: stroke volume.

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