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.
Highlights
Dialysis-induced hemodynamic instability has been associated with increased risk of cardiovascular (CV) mortality
We hypothesize that the impaired hemodynamic control can be prognostic indicators for subsequent CV events in end stage renal diseaes (ESRD) patients and the dynamics of the intradialytic hemodynamic parameters derived from impedance cardiography were quantified to explore the association of hemodynamic parameters and CV events in hemodialysis patients
We applied the dynamics of several hemodynamic parameters on a beat-by-beat basis, including HR, stroke volume (SV), cardiac index (CI) and Systemic vascular resistance indexes (SVRI) recorded from an impedance cardiograph, to explore the underlying mechanisms
Summary
Dialysis-induced hemodynamic instability has been associated with increased risk of cardiovascular (CV) mortality. The relationship between the pre- and post-hemodialysis BP changes and all-cause mortality in the end-stage renal disease (ESRD) patients was described as “U- or J-shaped associations with lowest risk around −20 mm-Hg between post- and pre-dialysis BP in two observational studies ”8,9. The relatively stable BP in a constantly changing environment is the physiologic response of continuously fine-tuning the hemodynamic variables including cardiac output [(stroke volume (SV) * heart rate (HR)] and systemic vascular resistance (SVR) by the underlying control mechanisms. We hypothesize that the impaired hemodynamic control can be prognostic indicators for subsequent CV events in ESRD patients and the dynamics of the intradialytic hemodynamic parameters derived from impedance cardiography were quantified to explore the association of hemodynamic parameters and CV events in hemodialysis patients
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