Altered Autonomic Reactivity During Lower Body Negative Pressure in End-Stage Renal Disease

• Type of Material: Article
• Authors: Kara Ye, Emory University; Ida Fonkoue, Emory University; Yunxiao Li, Emory University; Dana R. DaCosta, Emory University; Amit Shah, Emory University; Jeanie Park, Emory University
• Language: English
• Date: 2019-07-01
• Publisher: Elsevier Science Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Published by Elsevier Inc. on behalf of Southern Society for Clinical Investigation.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amjms.2019.04.003
• Title of Journal or Parent Work: American Journal of the Medical Sciences
• Volume: 358
• Issue: 1
• Start Page: 11
• End Page: 18
• Grant/Funding Information: In addition, the work was funded by and does not necessarily reflect the views of the National Institute of Health.; Howard Hughes Medical Institute Science Education Program award #52006923 to Emory University;; This work was supported by National Institutes of Health (NIH) HL-098744; Merit Review Award I01CX001065 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research;; NIH DK-101390; Norman S. Coplon Award, Satellite healthcare, a not-for-profit renal care provider;; NIH NIDDK grant R25DK101390; Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the Howard Hughes Medical Institute or Emory University.
• Keywords: Cardiovascular patients; Power spectrum analysis; Autonomic function; End-stage renal disease (ESRD); Amlopidine; Baroceptor; Life Sciences & Biomedicine; Sympathetic activity; Hypertensive patients; Parasympathetic activity; Blood pressure variability; Medicine, General & Internal; Blood pressure; Dysfunction; Science & Technology; Heart rate variability; Hypotension; Baroflex; General & Internal Medicine
• Research Categories: Health Sciences, Health Care Management; Biology, Biostatistics; Health Sciences, Medicine and Surgery; Biology, Bioinformatics

Abstract

Background: End stage renal disease (ESRD) is characterized by autonomic dysfunction. During orthostatic stress, sympathetic (SNS) activity increases and parasympathetic (PNS) activity decreases to maintain arterial blood pressure (BP). We hypothesized that ESRD patients have impaired ability to adjust cardiac SNS and PNS activity during orthostasis, which could contribute to increased blood pressure variability, orthostatic intolerance and falls. Methods: We measured beat-to-beat BP and Electrocardiography at baseline and during increasing lower body negative pressure (LBNP) in 20 ESRD patients and 18 matched controls (CON). Heart rate variability was quantified as total power (TP) and standard deviation of the N-N interval, reflecting both SNS and PNS; high frequency (HF), root mean square of successive differences of neighboring N-N intervals (RMSSD), and percent of consecutive N-N intervals differing >50 milliseconds (pNN50), reflecting cardiac PNS activity; and low frequency (LF) and LF/HF, reflecting sympoathovagal balance. BP variability was quantified as the standard deviation in systolic (SDSAP) and diastolic (SDDAP) BP. Results: Baseline HF, RMSSD, and pNN50 were significantly lower in ESRD (P < 0.05). While CON had a significant decrease in HF (P = 0.015), RMSSD (P = 0.003), and pNN50 (P = 0.005) during LBNP, there was no change in heart rate variability in ESRD. There was no significant difference in BP response, but ESRD had a significantly blunted heart rate response during graded LBNP compared to controls (P < 0.001). There was no significant difference in SDSAP or SDDAP during LBNP between groups (P > 0.05). Conclusions: These data suggest that ESRD patients have impaired autonomic adjustments to orthostatic stress.