title: Nocturnal hemodialysis increases arterial baroreflex sensitivity and compliance and normalizes blood pressure of hypertensive patients with end-stage renal disease.
abstract: BACKGROUND
  Impaired neural control of heart rate, elevated arterial stiffness, and hypertension place patients with end-stage renal disease (ESRD) at increased risk of cardiovascular mortality. Nocturnal hemodialysis (6 x 8 hours/week), a more intense program than conventional hemodialysis (3 x 4 hours/week), lowers blood pressure and restores brachial dilator responses to hyperemia and nitrates.
  
  
  METHODS
  We hypothesized that nocturnal hemodialysis would increase arterial baroreflex sensitivity for heart rate of hypertensive ESRD patients by an afferent vascular mechanism. Ten consecutive hypertensive ESRD patients (age 42 +/- 4) (mean +/- SEM) receiving conventional hemodialysis were studied before and 2 months after conversion to nocturnal hemodialysis. Regression slopes relating RR interval responses to rises or falls in systolic blood pressure were averaged to derive spontaneous baroreflex sensitivity for heart rate for each patient, and the stroke volume/pulse pressure ratio was used to estimate total arterial compliance.
  
  
  RESULTS
  Dialysis dose (Kt/V per session) increased from 1.2 +/- 0.05 to 2.1 +/- 0.1 (P < 0.05). Despite withdrawal of antihypertensive medications (from 2.9 to 0.1 drugs/patient), nocturnal hemodialysis lowered systolic blood pressure (from 143 +/- 4 to 120 +/- 6 mm Hg) (P= 0.001). Both baroreflex sensitivity (from 4.76 +/- 1.1 msec/mm Hg to 6.91 +/- 1.1 msec/mm Hg) (P= 0.04) and total arterial compliance (from 0.98 +/- 0.13 mL/mm Hg to 1.43 +/- 0.2 mL/mm Hg) (P= 0.02) were higher following conversion to nocturnal hemodialysis. Increases in baroreflex sensitivity correlated with increases in stroke volume/pulse pressure (r= 0.845, P= 0.002).
  
  
  CONCLUSIONS
  These findings are consistent with the concept that nocturnal hemodialysis increases baroreflex sensitivity via greater afferent baroreceptor responsiveness to pulsatile pressure. A more favorable risk profile, due to enhanced baroreflex regulation of the circulation and vascular compliance, may translate into lower cardiovascular event rates in ESRD patients receiving nocturnal hemodialysis.
authors.affiliation: University Health Network and Mount Sinai Hospital Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
authors.forename: Vipan
authors.initials: V
authors.lastname: Jain
authors.forename: Peter
authors.initials: P
authors.lastname: Picton
authors.forename: Andreas
authors.initials: A
authors.lastname: Pierratos
authors.forename: John S
authors.initials: JS
authors.lastname: Floras
mesh_terms: D000328:Adult; D017704:Baroreflex; D001794:Blood Pressure; D002940:Circadian Rhythm; D003187:Compliance; D005260:Female; D006339:Heart Rate; D006801:Humans; D006977:Hypertension, Renal / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D009551:Night Care; D006435:Renal Dialysis / Q000379:methods*; D013318:Stroke Volume