title: Attenuated cardiovascular response to sympathetic system activation during exercise in patients with dialysis-induced hypotension.
abstract: BACKGROUND
  We wished to investigate potential causes of dialysis-induced hypotension (DIH), including the attenuated cardiovascular response to sympathetic system activation during exercise and myocardial dysfunction.
  
  
  METHODS
  This study included 26 end-stage renal disease (ESRD) patients with DIH, 30 ESRD patients without DIH (Non-DIH), and 30 control subjects. Each patient was evaluated with echocardiography and a symptom-limited treadmill stress test. The chronotropic index (CRI), heart rate recovery (HRR), systolic blood pressure response to exercise (SBP response), and tissue Doppler systolic myocardial velocities were calculated.
  
  
  RESULTS
  The HRR and velocities were reduced in dialysis patients compared to controls; however, they were similar in patients with and without DIH. Patients with DIH had the lowest CRI compared to the Non-DIH group (0.62 ± 0.15 vs. 0.73 ± 0.17, p = 0.020) and controls (0.62 ± 0.15 vs. 0.86 ± 0.11, p < 0.001). Similarly, patients with DIH had the lowest SBP response values compared to the Non-DIH (34.88 ± 15.01 vs. 55.67 ± 25.42, p = 0.002) and controls (34.88 ± 15.01 vs. 59.70 ± 23.04, p < 0.001).
  
  
  CONCLUSIONS
  Patients with DIH have inadequate sympathetic activity of the cardiovascular system during exercise and impaired left ventricular systolic function. Both factors could contribute to the development of hypotension during hemodialysis.
authors.affiliation: Division of Cardiology, Goztepe Medical Park Hospital, Istanbul, Turkey. hakan_fotbolcu@yahoo.com
authors.forename: Hakan
authors.initials: H
authors.lastname: Fotbolcu
authors.forename: Dursun
authors.initials: D
authors.lastname: Duman
authors.forename: Sebahat Alısır
authors.initials: SA
authors.lastname: Ecder
authors.forename: Vecih
authors.initials: V
authors.lastname: Oduncu
authors.forename: Cihan
authors.initials: C
authors.lastname: Cevik
authors.forename: Kursat
authors.initials: K
authors.lastname: Tigen
authors.forename: Gokce
authors.initials: G
authors.lastname: Sirin
authors.forename: Emre
authors.initials: E
authors.lastname: Ozker
authors.forename: Burak
authors.initials: B
authors.lastname: Kiran
authors.forename: Yelda
authors.initials: Y
authors.lastname: Basaran
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D057774:Post-Exercise Hypotension / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D006435:Renal Dialysis / Q000009:adverse effects*; D013564:Sympathetic Nervous System / Q000503:physiopathology*