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Baroreflex function, haemodynamic responses to an orthostatic challenge, and falls in haemodialysis patients.
- Source :
-
PloS one [PLoS One] 2018 Dec 06; Vol. 13 (12), pp. e0208127. Date of Electronic Publication: 2018 Dec 06 (Print Publication: 2018). - Publication Year :
- 2018
-
Abstract
- Background: Stage 5 chronic kidney disease patients on haemodialysis (HD) often present with dizziness and pre-syncopal events as a result of the combined effect of HD therapy and cardiovascular disease. The dysregulation of blood pressure (BP) during orthostasis may be implicated in the aetiology of falls in these patients. Therefore, we explored the relationship between baroreflex function, the haemodynamic responses to a passive orthostatic challenge, and falls in HD patients.<br />Methods: Seventy-six HD patients were enrolled in this cross-sectional study. Participants were classified as "fallers" and "non-fallers" and completed a passive head up tilting to 60o (HUT-60°) test on an automated tilt table. ECG signals, continuous and oscillometric BP measurements and impedance cardiography were recorded. The following variables were derived from these measurements: heart rate (HR) stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR), number of baroreceptor events, and baroreceptor effectiveness index (BEI).<br />Results: The forty-four participants who were classified as fallers (57.9%) had a lower number of baroreceptor events (6.5±8.5 vs 14±16.7, p = .027) and BEI (20.8±24.2% vs 33.4±23.3%, p = .025). In addition, fallers experienced a significantly larger drop in systolic (-6.4±10.9 vs -0.4±7.7 mmHg, p = .011) and diastolic (-2.7±7.3 vs 1.8±6 mmHg, p = .027) oscillometric BP from supine to HUT-60° compared with non-fallers. None of the variables taken for the analysis were significantly associated with falls in multivariate logistic regression analysis.<br />Conclusions: This cross-sectional comparison indicates that, at rest, HD patients with a positive history of falls present with a lower count of baroreceptor sequences and BEI. Short-term BP regulation warrants further investigation as BP drops during a passive orthostatic challenge may be implicated in the aetiology of falls in HD.<br />Competing Interests: The authors have declared that no competing interests exist.
- Subjects :
- Aged
Baroreflex physiology
Blood Pressure physiology
Cardiac Output physiology
Cross-Sectional Studies
Dizziness diagnosis
Dizziness etiology
Female
Heart Rate physiology
Humans
Kidney Failure, Chronic complications
Kidney Failure, Chronic physiopathology
Male
Middle Aged
Stroke Volume physiology
Syncope diagnosis
Syncope etiology
Tilt-Table Test
Vascular Resistance physiology
Accidental Falls prevention & control
Dizziness physiopathology
Kidney Failure, Chronic therapy
Renal Dialysis adverse effects
Syncope physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1932-6203
- Volume :
- 13
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- PloS one
- Publication Type :
- Academic Journal
- Accession number :
- 30521545
- Full Text :
- https://doi.org/10.1371/journal.pone.0208127