Department of Cardiology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
Department of Nephrology, İstinye University, İstanbul, Turkey.
Int Urol Nephrol. 2020 Apr;52(4):775-782. doi: 10.1007/s11255-020-02429-7. Epub 2020 Mar 10.
Sudden cardiac death is the leading cause of cardiac-related death in hemodialysis patients. Hypotensive episodes in pre-, intra-, and post-dialytic periods can present serious clinical challenges that affect a patient's quality of life and prognosis. The aim of the present study was to evaluate cardiac autonomic control and arrhythmogenic risk by analyzing 24-h heart rate variability (HRV) and heart rate turbulence (HRT) in hypotensive hemodialysis patients.
A total of 79 patients on maintenance hemodialysis treatment, 39 normotensive and 40 with frequent hypotension episodes during non-dialysis periods, were included in the study. Dialysis-free periods were recorded with a 24-h Holter rhythm and ambulatory blood pressure monitor device. The time-domain parameters of HRV and HRT, including turbulence onset (TO) and turbulence slope (TS), were calculated.
Values for SDNN (105.5 ± 7.02, 127.6 ± 6.2 p < 0.001), SDANN (95.1 ± 5.9, 111.8 ± 5.01 p < 0.001), and SDNN index (50.04 ± 2.7, 55.6 ± 3.7 p = 0.03), in the hypotensive group were significantly lower than in the normotensive group, respectively. Values for RMSSD (26.5 ± 2.5, 27.3 ± 2.7 p = 0.178), pNN50 (17 ± 1.7, 55.6 ± 3.7 p = 0.03), and Tİ (35.1 ± 3.1, 34.7 ± 2.6 p = 0.542) in both groups were not significantly different; however, there was a significant difference between HRT parameters, TO (- 1.8 ± 0.37, - 2.4 ± 0.39 p < 0.001) and TS (6.9 ± 0.71, 8.2 ± 0.97 p < 0.001), respectively, hypotensive and normotensive group.
Dialysis patients that experience frequent hypotensive episodes may also undergo significant changes in HRT and HRV which may be indicative of serious cardiac sequela. Thus, in such cases, a complete cardiologic evaluation is warranted.
心脏性猝死是血液透析患者心脏相关死亡的主要原因。透析前、透析中和透析后低血压发作会带来严重的临床挑战，影响患者的生活质量和预后。本研究旨在通过分析 24 小时心率变异性（HRV）和心率震荡（HRT）评估低血压血液透析患者的心脏自主神经控制和心律失常风险。
共纳入 79 名维持性血液透析治疗患者，39 名血压正常，40 名透析间期频繁出现低血压发作。非透析期通过 24 小时动态心电图和动态血压监测仪记录。计算 HRV 和 HRT 的时域参数，包括震荡起始（TO）和震荡斜率（TS）。
与血压正常组相比，低血压组的 SDNN（105.5±7.02，127.6±6.2 p<0.001）、SDANN（95.1±5.9，111.8±5.01 p<0.001）和 SDNN 指数（50.04±2.7，55.6±3.7 p=0.03）明显降低。而 RMSSD（26.5±2.5，27.3±2.7 p=0.178）、pNN50（17±1.7，55.6±3.7 p=0.03）和 Tİ（35.1±3.1，34.7±2.6 p=0.542）在两组间差异无统计学意义。然而，HRT 参数 TO（-1.8±0.37，-2.4±0.39 p<0.001）和 TS（6.9±0.71，8.2±0.97 p<0.001）在低血压和血压正常组间有显著差异。
透析期间频繁发生低血压发作的患者可能也会出现 HRT 和 HRV 的显著变化，这可能提示严重的心脏后遗症。因此，在这种情况下，需要进行全面的心脏评估。
