CARDIAC AUTONOMIC DYSFUNCTION & PERITONEAL DIALYSIS TECHNIQUE SURVIVAL

What is it about?

The relationship problem of cardiac autonomic dysfunction in peritoneal dialysis (PD) patients to dialysis adequacy and technique survival has never been investigated before. METHODS: In this cross-sectional study, the associations between heart rate variability (HRV) measures and the indicators of dialysis adequacy in 44 PD patients (average age 50.8±12.5) were analysed. HRV was measured by using 5-min recordings of a stationary system by a standardized method. Both temporal domain and spectral domain parameters were analysed. The dialysis adequacy indices were evaluated taking into account weekly creatinine clearance (CrCl) and total weekly urea clearance (Kt/V). All the statistical analyses were performed using MedCalc. RESULTS: A significantly higher activity of the sympathetic cardiac activity was observed in the patients with inadequate dialysis dose (Kt/V<1.7), as evidenced by a decrease in SDNN (53.5 [28.5-73] vs 121 [72-195] p = 0.001).The parasympathetic activity of both temporal (RMSSD, CV) and spectral parameters of HRV (HF) had a moderate negative correlation with the PD adequacy (r = -0.43, p = 0.008; r = -0.36, p = 0.006 and r = -0.37, p = 0.005, according to the indicators). The spectral domain parameter LF, which reflected the relative vasomotor centre activity, had a direct correlation with CrCl (r = 0.53, p = 0.008). The coefficient of variation (CV) had a direct correlation with the status of residual renal function (r = 0.53; p < 0.0001). The preservation of dialysis adequacy was significantly dependent on the sympathetic activity (VLF and CV). The increase of 30% or more for VLF demonstrated the technique survival as 21.8 ± 2 (95% CI 17.8-25.9) months, while the technique survival in the patients with normal sympathetic activity (VLF<30%) was 46.5 ± 5.2 (95% CI 36.4-56.6) months (p = 0.0001). CONCLUSIONS: Our study has demonstrated the relationship of cardiac autonomic dysfunction with the PD adequacy. We suggest that the reduction in sympathetic hyperactivity can improve the PD adequacy and technique survival.

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