Abstract
Background and Aims
Few studies have focused on the imbalance of the autonomic nervous system during hemodialysis (HD), although it seems to be an important factor for the maintenance of blood pressure.
The aim of this work was to assess the impact of hemodialysis (HD) and glucose injection upon entropy of heart rate and blood pressure during HD session in end stage renal disease (ESRD) patients with and without diabetes mellitus (DM) type 2.
Method
21 patients without DM (NDO), in age 54,95 +/-13,08 y.o., and 10 DM patients, in age 69,70 +/- 8,27 y.o., were studied during HD. 30 minutes after dialysis begins, 40% glucose solution was administered in the amount of 0.5g/kg body dry-weight (constant rate of 1 mL/s). The cardiovascular signals were extracted from the recordings using Portapres® system. The analysis was performed using Amplitude Aware Permutation Entropy (AAPE). The parameters of AAPE were set as d=7, A=0.5. All statistical analysis were performed on significance level α=0.05. The comparisons between groups were conducted with Mann-Whitney test with Holm corrections. The comparisons in time points were performed using Friedman test with post-hoc (Wilcoxon test with Holm corrections). The calculations of AAPE and all statistical analysis were performed with Matlab R2020a and R.
Results
The results are presented in table.
It was found that AAPE(HR) tends to decrease during dialysis (NS) and increases only in the DM group after glucose injection (p=0.019); without difference between groups. There were no differences in AAPE of blood pressure between the groups, but hemodialysis reduces AAPE(fiSYS) in both groups (p<0.001 in both DM and NDO groups) and AAPE(fiDIA) in NDO (p<0.01). AAPE(TPR) is high before dialysis, and decreases during HD in both groups (p<0.0001). There is no effect of glucose injection on AAPE(HR) in both groups, but AAPE(fiSYS) and AAPE(fiDIA) increase in NDO (p<0.001, p<0.01, p<0.05 respectively); without difference between groups. AAPE(TPR) tends to increase after glucose injection (p<0.05 for NDO, NS for DM).
Conclusion
AAPE(HR)tends to decrease during HD, and glucose injections increase AAPE(HR) in DM patients. Hemodialysis reduce, and glucose injections increase AAPE of blood pressure especially in NDO. A weaker response to hemodialysis and glucose injection in diabetic patients may be caused by impairment of the autonomic system, and may have clinical impact – may leads to faint. Glucose administration does not prevent autonomic system disorders in patients with DM.