Effect of icodextrin on heart rate variability in diabetic patients on peritoneal dialysis

Abstract

Introduction: Spectral analysis of heart rate variability is a noninvasive method for evaluating autonomic cardiovascular dysfunction under various clinical conditions, such as in dialysis patients, in whom an imbalance between the sympathetic and parasympathetic nervous system appears to be an important risk factor for sudden cardiovascular death and arrhythmia. ♢

Objective: We compared the effect of icodextrin-based dialysis solution, an option that allows for better metabolic and fluid overload control, with that of glucose-based dialysis fluid on sympathetic and parasympathetic activity in the heart, as assessed by heart rate variability, in diabetic patients on peritoneal dialysis (PD). ♢

Methods: This secondary analysis uses data from a randomized controlled trial in diabetic PD patients with high or high-average peritoneal transport using icodextrin-based (ICO group, n = 30) or glucose-based (GLU group, n = 29) solutions for the long dwell. All patients underwent 24-hour electrocardiographic Holter monitoring at baseline, and at 6 and 12 months of follow-up. ♢

Results: We observed no significant differences between the groups in most of the variables analyzed, although values were, in general, below reference values. In the ICO group, total power and both low- and high-frequency power in normalized units increased, but the percentage of RR intervals with variation of more than 50 ms declined over time; in the GLU group, all those values declined. Plasma catecholamine levels were higher at baseline and declined over time. ♢

Conclusions: These results indicate a partial recovery of sympathetic activity in the ICO group, probably because of better extracellular fluid control and lower exposure to glucose with the use of icodextrin-based dialysis solutions.

Keywords: End-stage renal disease; diabetes; heart rate variability; high peritoneal transport type; icodextrin.

Figure 1 —

Changes (Δ) in parameters of heart rate variability during follow-up. (A) Change in total power frequency. (B) Change in low-frequency normalized units. (C) Change in high-frequency normalized units. (D) Change in pNN50 (percentage of RR intervals with more than 50 ms variation). GLU = patients using glucose dialysate; ICO = patients using icodextrin dialysate.

Figure 2 —

Plasma norepinephrine (NE) levels during follow-up. GLU = patients using glucose dialysate; ICO = patients using icodextrin dialysate.