Differences in Heart Rate Variability Between Diabetic and Non-diabetic Intradialytic Hypotensive Patients

Abstract

The most frequent and troubling side effect in the treatment of hemodialysis is intradialytic hypotension (IDH). This compromises cardiovascular hemodynamics. Heart rate variability (HRV) is a non-invasive measurement of the sympathovagal balance, and provides important information about the autonomic nervous system. Few studies have compared hypotension in diabetic and non-diabetic patients throughout the therapy sessions, with a protocol of intradialytic exercise and high flux hemodialysis/hemodiafiltration therapy. Our work is aimed to evaluate cardiac autonomic regulation during hemodialysis with HRV in hemodynamically unstable patients with chronic renal disease. During a 6-month follow-up of patients, the model suggested that the sympathovagal index (LF/HF) is different between the diabetic from non-diabetic group (p < 0.05), and does not necessarily reflect the sympathetic balance. Diabetic patients were differentiated by having lower HRV power components than the non-diabetic group (p < 0.05), and during the hypotensive event they showed a sympathetic inhibition, unlike the non-diabetic group that showed a parasympathetic inhibition. It was observed that the compensatory mechanisms were markedly different between two groups studied. This study shows the importance of giving individualized attention and therapies in order to take preventive measures to avoid hypotensive events.