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Abstract: TH-PO480

Renal Transplantation Improves Cardiovascular Autonomic Efficiency and Decreases Stroke Volume Variability in Chronic Hemodialysis Patients

Session Information

Category: Hypertension and CVD

  • 1403 Hypertension and CVD: Mechanisms

Authors

  • Sapoznikov, Dan, Hadassah University Medical Center, Jerusalem, Israel
  • Dranitzki Elhalel, Michal, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
  • Rubinger, Dvora, Hadassah University Medical Center, Jerusalem, Israel
Background


Renal transplantation (TX) was shown to enhance autonomic function and its cardiovascular efficiency (CvE), but its effect on stroke volume (SV) variability (sdSV), a measure of myocardial responsiveness consistency and poor prognostic significance was not defined.

Methods

Beat-to-beat systolic blood pressure (SBP) and interbeat intervals (IBI) monitoring was performed in 72 non-diabetic chronic hemodialysis (HD) patients (pts.), in 41 pts. after TX and in 27 healthy controls (C). The power spectral densities of IBI and SBP in the low frequency (LF) range were calculated from Finometer recordings of SBP and IBI spontaneous variations. SV and total peripheral resistance (TPR) were assessed using the ModelFlow method. The standard deviations (sd) of the above indices were considered to represent their variabilities. Differences in variability indices between SBP periods, 10% above (high) or below (low) the mean SBP were considered representative of CvE.

Results

: Table 1 (see below) lists hemodynamic data and SBP and IBI variability indices during low-high SBP periods. These periods were associated with increased SV and TPR in all groups and decreased sdSV in HD. SBP and IBI variability changes between low-high periods were blunted in HD and restored in TX. Overall sdSV was significantly increased in HD (p=0.025 and 0.001 vs C and TX). Overall LFIBI was lower in HD (p=0.001 vs C). LF SBP decreased after TX (p=0.001 vs HD).

Conclusion

In HD, increased LF SBP, decreased LF IBI and the attenuated variation between low-high SBP episodes are consistent with sympatheric overactivity and suppressed overall autonomic function. Renal TX improves CvE and decreases sdSV,suggesting enhanced myocardial responsiveness.These effects may contribute to the improved survival after TX .

Table 1.( median and interquartile ranges).
 CHDTX
Low-High SBPpLow-High SBPpLow-High SBPp
SBP (mmHg)104 (20) 137 (24)0.001113 (24) 155 (30)0.001108 (22) 141 (29)0.001
sdSBP (mmHg)5.03 (3.50) 7.23 (2.80)0.0016.87 (2.70) 6.94 (2.40)NS5.12 (2.20) 7.05 (2.70)0.001
IBI (ms)798 (116) 758 (110)0.001815 (168) 828(174)0.044828 (188) 802 (205)0.004
sdIBI (ms)39 (25) 42 (21)0.01324 (17) 23 (18)NS21 (19) 31 (24)0.001
LF SBP (mm Hg 2 /Hz)52 (96) 138 (108)0.003123 (114) 114 (138)NS53 (52) 108 (87)0.001
LF IBI (ms2/Hz)4467 (6005) 4076 (5154)NS1250 (2366) 1174 (2822)NS1059 (2544) 2465 (6282)0.001
SV (ml)75 (30) 79 (22)0.00181 (36) 86 (36)0.00181 (41) 84 (38)0.026
sdSV (ml)4.51 (2.07) 5.66 (3.06)NS7.25 (3.27) 6.21 (2.73)0.0015.36 (3.22) 4.98 (3.18)NS
TPR (mmHg.s/ml)0.852 (0.240) 0.942 (0.220)0.0130.842 (0.360) 1.021 (0.440)0.0010.800 (0.580) 0.893 (0.490)0.001