Effects of fluid overload on heart rate variability in chronic kidney disease patients on hemodialysis.
BACKGROUND
While fluid overload (FO) and alterations in the autonomic nervous system (ANS) such as hypersympathetic activity, are known risk factors for cardiovascular morbidity and mortality in patients on chronic hemodialysis (HD), their relationship has not been thoroughly studied.


METHODS
In this observational study involving 69 patients on chronic HD, FO was assessed by whole body bioimpedance measurements before the midweek HD session and ANS activity reflected by Heart Rate Variability (HRV) was measured using 24-hour Holter electrocardiogram recordings starting before the same HD treatment. In total, 13 different HRV indices were analyzed, comprising a mixture of time domain, frequency domain and complexity parameters. A correlation analysis was performed between the HRV indices and hydration status indices. Successively, patients were retrospectively assigned to a high FO (H, FO > 2.5 L) or low FO (L, FO ≤ 2.5 L) group and these were further compared also after stratification by diabetes mellitus. Finally, a small number of patients without diabetes with significant and persistent FO were followed up for 3 months post-study to investigate how normalization of fluid status affects HRV.


RESULTS
SDANN, VLF, LZC and HF% parameters significantly correlate with FO (correlation coefficients were respectively r = -0.40, r = -0.37, r = -0.28 and r = 0.26, p-value < 0.05). Furthermore, LF% and LF/HF were inversely correlated with hydration status (correlation coefficients were respectively r = -0.31 and r = -0.33, p-value < 0.05). These results indicate an association between FO and reduced HRV, higher parasympathetic activation and reduced sympathetic response to the HD session. Indeed, group H tended to have lower values of SDANN, VLF and LZC, and higher values of HF% than patients in the L group. Finally, there was a trend towards lower LF% measured during the last 30 minutes of HD for the H group versus the L group. Reduction in FO achieved over 3 months by implementation of a strict fluid management plan resulted in an increase of HRV.


CONCLUSIONS
Our results suggest that depressed HRV is associated with fluid overload and that normalization of hydration status is accompanied by improved HRV.
Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, P,zza Leonardo da Vinci 32, Milano, Italy. manuela.ferrario@polimi.it.
Manuela
M
Ferrario
Ulrich
U
Moissl
Francesco
F
Garzotto
Dinna N
DN
Cruz
Anna
A
Clementi
Alessandra
A
Brendolan
Ciro
C
Tetta
Emanuele
E
Gatti
Maria G
MG
Signorini
Sergio
S
Cerutti
Claudio
C
Ronco
D000368:Aged; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*