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. 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

Sook H Park  1   2 , Ida T Fonkoue  1   2 , Yunxiao Li  3 , Dana R DaCosta  1   2 , Holly R Middlekauff  4 , Jeanie Park  1   2
Affiliations

Augmented Cardiopulmonary Baroreflex Sensitivity in Intradialytic Hypertension

Sook H Park et al. Kidney Int Rep. .

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 (P = 0.044) during graded LBNP in the ID-HTN group, suggesting heightened cardiopulmonary BRS. The ID-HTN group also had a trend toward increased diastolic BP response during LBNP, and had significantly greater increases in BP during the cold pressor test.

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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Figures

Figure 1
Figure 1
Change in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) during low-dose and high-dose graded lower body negative pressure (LBNP) in end-stage renal disease patients prone to intradialytic hypertension (ID-HTN, n = 10) and controls (n = 12).
Figure 2
Figure 2
Change in muscle sympathetic nerve activity (MSNA) burst incidence (BI) and burst frequency in the intradialytic hypertension (ID-HTN) group (n = 7) versus controls (n = 7). *P < 0.05 denotes a statistically significant difference in change between groups. HB, heart beat; LBNP, lower body negative pressure.
Figure 3
Figure 3
Change in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) during the cold pressor test in a subset of participants from the intradialytic hypertension (ID-HTN) group (n = 5) and controls (n = 6). BP, blood pressure. *P < 0.05 denotes a statistically significant difference between groups.
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