Relationship Between Cardiac Autonomic Control and Intradialytic Hypotension in Senegalese Chronic Hemodialysis Patients: A Single Center Prospective Study.

Abstract

Background: Intradialytic hypotension (IDH) increases cardiovascular morbidity and mortality in chronic hemodialysis patients and cardiac autonomous neuropathy (CAN) might be involved. To assess cardiac autonomic control in hemodialysis patients and describe its relationship with IDH.

Methods: We conducted a prospective study at Ouakam Military Hospital in Senegal from January 1st to March 31st, 2023. Fifty-two patients (31 men, mean age 47.54 years) were included and had 3 measurements of heart rate variability (HRV): before, during and after an index hemodialysis session. They were classified according to changes in systolic blood pressure (SBP) during hemodialysis into three groups: 14 patients in group I (increase > 10 mmHg in mean intradialytic SBP), 13 in group II (decrease ≥ 20 mmHg in mean intradialytic SBP or MAP > 10 mmHg) and 25 in group III (others). HRV frequency domain indices between groups were compared.

Results: In pre-dialysis, patients in group II showed higher values in total power (650.30 vs. 94.94 and 108.11 ms², p = 0.02), high frequency (199.24 vs. 25.05 and 25.90 ms², p = 0.03) and low frequency (225.36 vs. 42.30 and 53.76 ms², p = 0.01) compared to those in groups I and III. Also, they presented less severe CAN (16.2% vs. 57.2% and 56%, p = 0.03). Measures after dialysis found no difference in HRV parameters among the three groups.

Conclusion: Our results found that HRV was similar between patients with and without IDH suggesting the influence of other risk factors that need to be explored in further studies.