Heart Rate Variability Assessment Using Time–Frequency Analysis in Hypotensive and Non-Hypotensive Patients in Hemodialysis

Brayans Becerra-Luna,José Manuel Rodríguez-Chagolla,Héctor Pérez-Grovas,Raúl Martínez-Memije,Raúl Cartas-Rosado,Oscar Infante-Vázquez,Gabriel Sánchez-Pérez,Miguel Cadena-Méndez,Juan Carlos Sánchez-García,Claudia Lerma

doi:10.3390/app10176074

Brayans Becerra-Luna, José Manuel Rodríguez-Chagolla + Show 8 more

Open Access

https://doi.org/10.3390/app10176074

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Abstract

Intradialytic hypotension occurs in 10–30% of hemodialysis (HD) sessions. This phenomenon affects the cardiovascular system’s functions, which are reflected in the activity of the autonomic nervous system (ANS). To indirectly assess the ANS during HD, we analyzed the mean R–R intervals and the spectral power of heart rate variability (HRV) from 20 end-stage renal disease patients divided into hypotensive and non-hypotensive groups. The spectrotemporal analysis was accomplished using short-time Fourier transform with 10 min epochs of HRV overlapping by 40%. The spectral power was divided into three segments according to high frequency, low frequency, and very low frequency bandwidths and averaged to fit quadratic regression models. The analysis of the mean R–R intervals showed significant differences between the groups (p = 0.029). The power variation over time was significant in each spectral band (p ≪ 0.05). The average power, maximum power, and time when the peak was reached differed for each band and between groups, showing the ability to correctly identify the decompensation of the ANS and discriminate between hypotensive and non-hypotensive patients. Additionally, the changes in the sympathovagal ratio were not significant and very scattered for the hypotensive group (p = 0.23) compared to the non-hypotensive group, where the changes were significant (p ≪ 0.05) and much less scattered.

Highlights

The patient population with end-stage renal disease (ESRD) is increasing worldwide [1].Hemodialysis (HD) is one of the three renal replacement therapies for ESRD laterally with peritoneal dialysis and kidney transplant.HD is the second most convenient treatment after kidney transplant, but it has severe negative outcomes, as well as high costs and quality assurance (QA) difficulties [1]
The first mean value obtained from the R-R intervals is placed at 10 min, and the last mean value is at 184 min
Adjacent points are separated by 6 min according to the maximum overlap described in the heart rate variability (HRV) processing section to maximize the number of analysis points

Summary

Introduction

The patient population with end-stage renal disease (ESRD) is increasing worldwide [1].Hemodialysis (HD) is one of the three renal replacement therapies for ESRD laterally with peritoneal dialysis and kidney transplant.HD is the second most convenient treatment after kidney transplant, but it has severe negative outcomes, as well as high costs and quality assurance (QA) difficulties [1]. Hemodialysis (HD) is one of the three renal replacement therapies for ESRD laterally with peritoneal dialysis and kidney transplant. In Mexico, more than 65% of clinics have poor QA figures and report hypotension rates above 30%, leading to unacceptable lethality rates as high as 21% in less than 5 years. This situation has concerned the Mexican Health Care Delivery System since 2011, which has devoted research efforts to find a new method for prognosis to prevent hypotension events in patients undergoing HD [2,3]

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