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Park SH, Fonkoue IT, Li Y, et al. Augmented Cardiopulmonary Baroreflex Sensitivity in Intradialytic Hypertension. Kidney Int Rep. 2018;3(6):1394-1402doi: 10.1016/j.ekir.2018.07.025.
Park, S. H., Fonkoue, I. T., Li, Y., DaCosta, D. R., Middlekauff, H. R., & Park, J. (2018). Augmented Cardiopulmonary Baroreflex Sensitivity in Intradialytic Hypertension. Kidney international reports, 3(6), 1394-1402. https://doi.org/10.1016/j.ekir.2018.07.025
Park, Sook H, et al. "Augmented Cardiopulmonary Baroreflex Sensitivity in Intradialytic Hypertension." Kidney international reports vol. 3,6 (2018): 1394-1402. doi: https://doi.org/10.1016/j.ekir.2018.07.025
Park SH, Fonkoue IT, Li Y, DaCosta DR, Middlekauff HR, Park J. Augmented Cardiopulmonary Baroreflex Sensitivity in Intradialytic Hypertension. Kidney Int Rep. 2018 Aug 17;3(6):1394-1402. doi: 10.1016/j.ekir.2018.07.025. eCollection 2018 Nov. PMID: 30450466; PMCID: PMC6224617.
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Kidney Int Rep. 2018 Aug 17;3(6):1394-1402. doi: 10.1016/j.ekir.2018.07.025. eCollection 2018 Nov.

Augmented Cardiopulmonary Baroreflex Sensitivity in Intradialytic Hypertension.

Kidney international reports

Sook H Park, Ida T Fonkoue, Yunxiao Li, Dana R DaCosta, Holly R Middlekauff, Jeanie Park

Affiliations

  1. Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
  2. Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA.
  3. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
  4. Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA.

PMID: 30450466 PMCID: PMC6224617 DOI: 10.1016/j.ekir.2018.07.025

Abstract

INTRODUCTION: End-stage renal disease (ESRD) patients with a paradoxical increase in blood pressure (BP) during hemodialysis (HD), termed intradialytic hypertension (ID-HTN), are at significantly increased risk for mortality and adverse cardiovascular events. ID-HTN affects up to 15% of all HD patients, and the pathophysiologic mechanisms remain unknown. We hypothesized that ESRD patients prone to ID-HTN have heightened volume-sensitive cardiopulmonary baroreflex sensitivity (BRS) that leads to exaggerated increases in sympathetic nervous system (SNS) activation during HD.

METHODS: We studied ESRD patients on maintenance HD with ID-HTN (n = 10) and without ID-HTN (controls, n = 12) on an interdialytic day, 24 to 30 hours after their last HD session. We measured continuous muscle sympathetic nerve activity (MSNA), beat-to-beat arterial BP, and electrocardiography (ECG) at baseline, and during graded lower body negative pressure (LBNP). Low-dose LBNP isolates cardiopulmonary BRS, whereas higher doses allow assessment of physiologic responses to orthostatic stress.

RESULTS: The ID-HTN patients had significantly higher pre- and post-HD BP, and greater interdialytic fluid weight gain compared to controls. There was a significantly greater increase in MSNA burst incidence (

CONCLUSION: Patients with ID-HTN have augmented cardiopulmonary BRS that may contribute to increased SNS activation and BP response during HD.

Keywords: baroreflex; end-stage renal disease; hemodialysis; sympathetic activity

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