Department of Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey.
J Nephrol. 2012 Nov-Dec;25(6):1067-74. doi: 10.5301/jn.5000098.
Heart rate variability (HRV) is decreased in dialysis patients, and decreased HRV is an independent risk factor for sudden cardiac death. We aimed to determine the effect of sudden changes in serum electrolyte, bicarbonate concentration and blood pressure on HRV during hemodialysis (HD) sessions in chronic HD patients.
The study population included 75 HD patients (mean age 44.5 ± 10.3 years; 53% female, 13% diabetic) and 35 healthy volunteers (mean age 42.44 ± 11.5 years, 62% female). HRV indexes were analyzed from 24-hour ECG recordings. The time-domain HRV indexes (SDNN, SDANN, RMSSD, pNN50 [%] and HRV TAI) were calculated from these recordings. Pre- and post-HD blood samples were drawn from an arterial line to calculate Na+, K+, Ca2+, iCa2+ and HCO3- concentration gradients.
All HRV indexes were significantly lower in dialysis patients than in healthy volunteers (p<0.05).The detected SDNN and HRV TAI values were lower in diabetic patients than in nondiabetics. While K+ concentration was decreased, Ca2+ and bicarbonate increased significantly during HD.
HRV decreased in chronic HD patients. The decrease in HRV in diabetic uremic patients was higher than in uremic patients without diabetes. The change of serum electrolyte and bicarbonate concentrations during HD did not affect HRV.
透析患者的心率变异性（HRV）降低，而 HRV 降低是心脏性猝死的独立危险因素。我们旨在确定慢性血液透析（HD）患者在 HD 过程中血清电解质、碳酸氢盐浓度和血压的突然变化对 HRV 的影响。
研究人群包括 75 名血液透析患者（平均年龄 44.5±10.3 岁；53%为女性，13%为糖尿病患者）和 35 名健康志愿者（平均年龄 42.44±11.5 岁，62%为女性）。从 24 小时心电图记录中分析 HRV 指数。从这些记录中计算出时域 HRV 指数（SDNN、SDANN、RMSSD、pNN50[%]和 HRV TAI）。从动脉线抽取 HD 前后的血液样本，以计算 Na+、K+、Ca2+、iCa2+和 HCO3-浓度梯度。
所有 HRV 指数在透析患者中均明显低于健康志愿者（p<0.05）。与非糖尿病患者相比，糖尿病患者的 SDNN 和 HRV TAI 值较低。在 HD 过程中，K+浓度降低，而 Ca2+和碳酸氢盐浓度显著增加。
慢性 HD 患者的 HRV 降低。糖尿病尿毒症患者的 HRV 降低程度高于非糖尿病尿毒症患者。HD 期间血清电解质和碳酸氢盐浓度的变化不会影响 HRV。
