Abstract
Objective: We investigated the changes of spontaneous baroreflex sensitivity (BRS) in patients with chronic hemodialysis (HD) treatment. We did not focus on the basic disease at the background of HD treatment. Design and method: Spontaneous BRS were calculated immediately before and after a regular HD session in the Haemodiyalsis Center of the 1st Dept. of Med. in Szeged. Twenty-three dialysed patients on continuous antihypertensive medication (7 male, 16 female, number of HD: 268 ± 26, age: 62 ± 7 yrs; means ± SD) were investigated. The continuous finger blood pressure and ECG data were recorded with the Finometer (FMS, Arnhem, Netherlands) device. The data were analysed with the Nevrokard BRS (v. 5.1.3 Medistar) software. We calculated the time-domain up- and down-BRS and the frequency-domain alpha-index (a) in the low-frequency (LF) and high-frequency (HF) spectra both in a 10 minute-long resting supine position and in a 10 minute-long standing position. Further we calculated the LF/HF ratio being characteristic to sympathovagal balance and the total peripheral resistance (TPR). Results: Both the frequency- and the time-domain spontaneous BRS values decreased after standing up compared to the supine position before and after the HD session. All the BRS values were lower in both positions after the HD session compared to the before values. The LF/HF ratio increased after the standing up before and after the HD session and further it was higher in both positions after the HD session. The spontaneous BRS values were higher in patients taking beta-blockers. The TPR also increased after standing up and in both positions it was higher after the HD session. Conclusions: The pattern of changes of the spontaneous BRS of patients being on chronic HD program are similar to physiological pattern. The decrease of the spontaneous BRS and the increase of the TPR confirm the increased sympathetic activity which is a known consequence of HD. Our results also call attention to the fact that just a HD session alone means higher cardiovascular risk. A chronic beta-blocker therapy may improve the BRS and so helps to decrease the cardiovascular risk, even in dialysed patients.
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