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      Changes in Heart Rate Variability in Chronic Uremic Patients during Ultrafiltration and Hemodialysis

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          Background: The analysis of heart rate variability (HRV) is a useful tool to evaluate cardiac autonomic modulation, which is frequently impaired in chronic uremia. Aims: The aim of this study was to evaluate HRV in chronic uremics and to separately investigate the acute changes induced by volume depletion and solute removal during a hemodialysis session. Methods: Fourteen uremic patients (8 males and 6 females, aged 50 ± 15 years) on maintenance hemodialysis and 14 sex- and age-matched healthy controls were studied. Both groups underwent ambulatory electrocardiogram monitoring to evaluate the HRV time and frequency domain indices. The hemodialysis session was performed by 1 h of high-rate isolated ultrafiltration followed by 3 h of bicarbonate diffusive procedure. Results: In uremic patients, the overall variability in the frequency [low-frequency power (LF): 505 ± 473, vs. 1,446 ± 654; high-frequency power (HF): 133 ± 162 vs. 512 ± 417; p < 0.001] and time domain indices (standard deviation of normal R-R intervals: 101.9 ± 33.3 vs. 181.7 ± 44.1 ms; p < 0.001) was markedly reduced compared to controls, whereas mean heart rate (83 ± 12.4 vs. 60.9 ± 8.8 bpm; p < 0.001) and LF/HF ratio (5.8 ± 3.5 vs. 2.2 ± 0.8; p < 0.001) were increased. Isolated ultrafiltration produced a marked further decrease in HRV indices, but the subsequent diffusive hemodialysis procedure, with a low ultrafiltration rate, made HRV increase again. Conclusions: Chronic uremics showed abnormal autonomic modulation with sympathetic-vagal imbalance. The unbalanced hypersympathetic response to body fluid depletion is related to the ultrafiltration rate. Low interdialytic weight gain and a low ultrafiltration rate, associated with adequate hemodialysis, should be the preferable strategy for uremic patients with autonomic dysfunction.

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          Most cited references 3

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          Long, slow dialysis.

           B Charra,  C Chazot,  G. Jean (2000)
          Long slow hemodialysis (3 x 8 hours/week) has been used in Tassin for 30 years without significant change in the method. It provides excellent results in terms of morbidity and mortality. The better survival than usually reported on shorter dialysis is mainly due to lower cardiovascular mortality. The nutritional state of the patient is good, as well as the correction of anemia with low doses of EPO. But the main feature concerns blood pressure; hypertension is very well controlled without need for antihypertensive medications. The gentle ultrafiltration provided by a long session time associated with a low salt diet and a moderate interdialytic weight gain allows for normalization of the extracellular fluid space in most patients (dry weight) without important intradialytic morbidity. This low salt diet has paradoxically been forgotten in recent years while shortened dialysis time renders it more necessary than ever.
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            Does dialysis therapy improve autonomic and peripheral nervous system abnormalities in chronic uraemia?

            Autonomic nervous system (ANS) dysfunction and peripheral neuropathy occur in patients with chronic renal insufficiency. Adequate renal replacement therapy should prevent development or correct these abnormalities.
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              Plasma catecholamines in hypertension and pheochromocytoma determined using ion-pair reversed-phase chromatography with amperometric detection


                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                20 September 2001
                : 19
                : 4
                : 395-400
                aDepartment of Internal Medicine, University of Pisa, and bDivision of Nephrology, ASL of Pisa, Pisa, Italy
                46970 Blood Purif 2001;19:395–400
                © 2001 S. Karger AG, Basel

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                Page count
                Figures: 4, Tables: 2, References: 24, Pages: 6
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                Original Paper

                Cardiovascular Medicine, Nephrology

                Heart rate variability, Autonomic dysfunction, Hemodialysis


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