Abstract
Introduction: Patients with end-stage renal disease (ESRD) are susceptible to development of autonomic dysfunction and have metabolic and muscular changes which are associated with decreased functional capacity. Objectives: To evaluate respiratory muscle strength and cardiac autonomic modulation in ESRD patients undergoing hemodialysis. Methods: ESRD patients undergoing hemodialysis (n= 9, mean age 46.2±14.1 years) and healthy controls (n =7, mean age 44.6±14.6 years) were assessed. Non–invasive curves of blood pressure were recorded continuously (Finometer ®) for 10 minutes. The heart rate variability was estimated in the time and frequency domain. Inspiratory and expiratory maximal pressures (IPmax and EPmax) were quantified using a pressure transducer. Mann-Whitney and Spearman tests were used. The results were expressed as mean ± SD. Results: Regarding respiratory muscle strength, ESRD patients had lower inspiratory (IPmax: 79.1±25.0 vs 121.3±24.3cmH 2 O, p=0.03) and expiratory muscle strength (EPmax 92.8±23.1 vs 153.8±23.5cmH 2 O, p=0.01) then healthy controls. ESRD patients presented lower heart rate variability than healthy controls (SDNN: 19.2±4.0 vs 52.6±18.8ms, p=0.000) and lower RMSSD, an index of vagal modulation (11.8±5.2 vs 46.1±20.4ms, p=0.000). Regarding frequency domain indexes, ESRD patients presented higher low-frequency component (LFnu= 68.9±11.9 vs 47.3± 2.8, p=0.008), lower high-frequency component (HFnu= 31.1±11.9 vs 52.7±12.8, p=0.008) and higher sympathovagal balance (LF/HF: (LF/HF= 3.1±1.3 vs 1.1±0.5, p=0.005) when compared to controls. Furthermore baroreflex sensitivity was reduced in ESRD patients (alfa index: 3.6±1.6 vs 11.7±4.4ms/mmHg, p=0.002). In ESRD patients the IPmax was significantly associated with LF (r=-0.813, p=0.014) and with alfa index (r=-0.900, p=0.037). Conclusion: ESRD patients undergoing hemodialysis presented reduced inspiratory muscle strength, increased sympathetic modulation and reduced cardiac vagal modulation and impaired baroreflex sensitivity. In these patients inspiratory muscle strength was associated with sympathetic cardiac modulation and baroreflex.
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