Altered Autonomic Reactivity During Lower Body Negative Pressure in End-Stage Renal Disease

Kara Ye; Ida T. Fonkoue; Yunxiao Li; Dana R. DaCosta; Amit Shah; Jeanie Park

doi:10.1016/j.amjms.2019.04.003

Altered Autonomic Reactivity During Lower Body Negative Pressure in End-Stage Renal Disease

Kara Ye, Ida T. Fonkoue, Yunxiao Li, Dana R. DaCosta, Amit Shah, Jeanie Park

Research output: Contribution to journal › Article › peer-review

Abstract

Background: End stage renal disease (ESRD) is characterized by autonomic dysfunction. During orthostatic stress, sympathetic (SNS) activity increases and parasympathetic (PNS) activity decreases to maintain arterial blood pressure (BP). We hypothesized that ESRD patients have impaired ability to adjust cardiac SNS and PNS activity during orthostasis, which could contribute to increased blood pressure variability, orthostatic intolerance and falls. Methods: We measured beat-to-beat BP and Electrocardiography at baseline and during increasing lower body negative pressure (LBNP) in 20 ESRD patients and 18 matched controls (CON). Heart rate variability was quantified as total power (TP) and standard deviation of the N-N interval, reflecting both SNS and PNS; high frequency (HF), root mean square of successive differences of neighboring N-N intervals (RMSSD), and percent of consecutive N-N intervals differing >50 milliseconds (pNN50), reflecting cardiac PNS activity; and low frequency (LF) and LF/HF, reflecting sympoathovagal balance. BP variability was quantified as the standard deviation in systolic (SDSAP) and diastolic (SDDAP) BP. Results: Baseline HF, RMSSD, and pNN50 were significantly lower in ESRD (P < 0.05). While CON had a significant decrease in HF (P = 0.015), RMSSD (P = 0.003), and pNN50 (P = 0.005) during LBNP, there was no change in heart rate variability in ESRD. There was no significant difference in BP response, but ESRD had a significantly blunted heart rate response during graded LBNP compared to controls (P < 0.001). There was no significant difference in SDSAP or SDDAP during LBNP between groups (P > 0.05). Conclusions: These data suggest that ESRD patients have impaired autonomic adjustments to orthostatic stress.

Original language	English (US)
Pages (from-to)	11-18
Number of pages	8
Journal	American Journal of the Medical Sciences
Volume	358
Issue number	1
DOIs	https://doi.org/10.1016/j.amjms.2019.04.003
State	Published - Jul 2019
Externally published	Yes

Bibliographical note

Funding Information:
This work was supported by National Institutes of Health (NIH)HL-098744; Merit Review Award I01CX001065 from the United States (U.S.)Department of Veterans Affairs Clinical Sciences Research; NIH DK-101390; Norman S. Coplon Award, Satellite healthcare, a not-for-profit renal care provider; the Howard Hughes Medical Institute Science Education Program award #52006923 to Emory University; NIH NIDDK grant R25DK101390; Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s)and do not necessarily reflect the views of the Howard Hughes Medical Institute or Emory University. In addition, the work was funded by and does not necessarily reflect the views of the National Institute of Health. We gratefully acknowledge Doree Morison and Melanie Kankam for their expert assistance. An abstract presenting a preliminary version of these findings was presented at the Experimental Biology Meeting (2017).

Funding Information:
This work was supported by National Institutes of Health (NIH) HL-098744; Merit Review Award I01CX001065 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research; NIH DK-101390; Norman S. Coplon Award, Satellite healthcare, a not-for-profit renal care provider; the Howard Hughes Medical Institute Science Education Program award #52006923 to Emory University; NIH NIDDK grant R25DK101390; Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the Howard Hughes Medical Institute or Emory University. In addition, the work was funded by and does not necessarily reflect the views of the National Institute of Health. This work was supported by National Institutes of Health (NIH) HL-098744; Merit Review Award I01CX001065 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research; NIH DK-101390; Norman S. Coplon Award, Satellite healthcare, a not-for-profit renal care provider; the Howard Hughes Medical Institute Science Education Program award #52006923 to Emory University; NIH NIDDK grant R25DK101390; Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the Howard Hughes Medical Institute or Emory University. In addition, the work was funded by and does not necessarily reflect the views of the National Institute of Health. The authors have no financial or other conflicts of interest to disclose. We gratefully acknowledge Doree Morison and Melanie Kankam for their expert assistance. An abstract presenting a preliminary version of these findings was presented at the Experimental Biology Meeting (2017). This work was supported by National Institutes of Health (NIH) HL-098744; Merit Review Award I01CX001065 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research; NIH DK-101390; Norman S. Coplon Award, Satellite healthcare, a not-for-profit renal care provider; the Howard Hughes Medical Institute Science Education Program award #52006923 to Emory University; NIH NIDDK grant R25DK101390; Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the Howard Hughes Medical Institute or Emory University. In addition, the work was funded by and does not necessarily reflect the views of the National Institute of Health. The authors have no financial or other conflicts of interest to disclose.

Publisher Copyright:
© 2019

Keywords

Autonomic function
Blood pressure variability
End-stage renal disease (ESRD)
Heart rate variability
Parasympathetic activity
Sympathetic activity

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10.1016/j.amjms.2019.04.003

Cite this

@article{7eb9d952bbee4a11bacf3b4baf25f61c,

title = "Altered Autonomic Reactivity During Lower Body Negative Pressure in End-Stage Renal Disease",

abstract = "Background: End stage renal disease (ESRD) is characterized by autonomic dysfunction. During orthostatic stress, sympathetic (SNS) activity increases and parasympathetic (PNS) activity decreases to maintain arterial blood pressure (BP). We hypothesized that ESRD patients have impaired ability to adjust cardiac SNS and PNS activity during orthostasis, which could contribute to increased blood pressure variability, orthostatic intolerance and falls. Methods: We measured beat-to-beat BP and Electrocardiography at baseline and during increasing lower body negative pressure (LBNP) in 20 ESRD patients and 18 matched controls (CON). Heart rate variability was quantified as total power (TP) and standard deviation of the N-N interval, reflecting both SNS and PNS; high frequency (HF), root mean square of successive differences of neighboring N-N intervals (RMSSD), and percent of consecutive N-N intervals differing >50 milliseconds (pNN50), reflecting cardiac PNS activity; and low frequency (LF) and LF/HF, reflecting sympoathovagal balance. BP variability was quantified as the standard deviation in systolic (SDSAP) and diastolic (SDDAP) BP. Results: Baseline HF, RMSSD, and pNN50 were significantly lower in ESRD (P < 0.05). While CON had a significant decrease in HF (P = 0.015), RMSSD (P = 0.003), and pNN50 (P = 0.005) during LBNP, there was no change in heart rate variability in ESRD. There was no significant difference in BP response, but ESRD had a significantly blunted heart rate response during graded LBNP compared to controls (P < 0.001). There was no significant difference in SDSAP or SDDAP during LBNP between groups (P > 0.05). Conclusions: These data suggest that ESRD patients have impaired autonomic adjustments to orthostatic stress.",

keywords = "Autonomic function, Blood pressure variability, End-stage renal disease (ESRD), Heart rate variability, Parasympathetic activity, Sympathetic activity",

author = "Kara Ye and Fonkoue, {Ida T.} and Yunxiao Li and DaCosta, {Dana R.} and Amit Shah and Jeanie Park",

note = "Funding Information: This work was supported by National Institutes of Health (NIH)HL-098744; Merit Review Award I01CX001065 from the United States (U.S.)Department of Veterans Affairs Clinical Sciences Research; NIH DK-101390; Norman S. Coplon Award, Satellite healthcare, a not-for-profit renal care provider; the Howard Hughes Medical Institute Science Education Program award #52006923 to Emory University; NIH NIDDK grant R25DK101390; Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s)and do not necessarily reflect the views of the Howard Hughes Medical Institute or Emory University. In addition, the work was funded by and does not necessarily reflect the views of the National Institute of Health. We gratefully acknowledge Doree Morison and Melanie Kankam for their expert assistance. An abstract presenting a preliminary version of these findings was presented at the Experimental Biology Meeting (2017). Funding Information: This work was supported by National Institutes of Health (NIH) HL-098744; Merit Review Award I01CX001065 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research; NIH DK-101390; Norman S. Coplon Award, Satellite healthcare, a not-for-profit renal care provider; the Howard Hughes Medical Institute Science Education Program award #52006923 to Emory University; NIH NIDDK grant R25DK101390; Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the Howard Hughes Medical Institute or Emory University. In addition, the work was funded by and does not necessarily reflect the views of the National Institute of Health. This work was supported by National Institutes of Health (NIH) HL-098744; Merit Review Award I01CX001065 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research; NIH DK-101390; Norman S. Coplon Award, Satellite healthcare, a not-for-profit renal care provider; the Howard Hughes Medical Institute Science Education Program award #52006923 to Emory University; NIH NIDDK grant R25DK101390; Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the Howard Hughes Medical Institute or Emory University. In addition, the work was funded by and does not necessarily reflect the views of the National Institute of Health. The authors have no financial or other conflicts of interest to disclose. We gratefully acknowledge Doree Morison and Melanie Kankam for their expert assistance. An abstract presenting a preliminary version of these findings was presented at the Experimental Biology Meeting (2017). This work was supported by National Institutes of Health (NIH) HL-098744; Merit Review Award I01CX001065 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research; NIH DK-101390; Norman S. Coplon Award, Satellite healthcare, a not-for-profit renal care provider; the Howard Hughes Medical Institute Science Education Program award #52006923 to Emory University; NIH NIDDK grant R25DK101390; Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the Howard Hughes Medical Institute or Emory University. In addition, the work was funded by and does not necessarily reflect the views of the National Institute of Health. The authors have no financial or other conflicts of interest to disclose. Publisher Copyright: {\textcopyright} 2019",

year = "2019",

month = jul,

doi = "10.1016/j.amjms.2019.04.003",

language = "English (US)",

volume = "358",

pages = "11--18",

journal = "American Journal of the Medical Sciences",

issn = "0002-9629",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

TY - JOUR

T1 - Altered Autonomic Reactivity During Lower Body Negative Pressure in End-Stage Renal Disease

AU - Ye, Kara

AU - Fonkoue, Ida T.

AU - Li, Yunxiao

AU - DaCosta, Dana R.

AU - Shah, Amit

AU - Park, Jeanie

N1 - Funding Information: This work was supported by National Institutes of Health (NIH)HL-098744; Merit Review Award I01CX001065 from the United States (U.S.)Department of Veterans Affairs Clinical Sciences Research; NIH DK-101390; Norman S. Coplon Award, Satellite healthcare, a not-for-profit renal care provider; the Howard Hughes Medical Institute Science Education Program award #52006923 to Emory University; NIH NIDDK grant R25DK101390; Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s)and do not necessarily reflect the views of the Howard Hughes Medical Institute or Emory University. In addition, the work was funded by and does not necessarily reflect the views of the National Institute of Health. We gratefully acknowledge Doree Morison and Melanie Kankam for their expert assistance. An abstract presenting a preliminary version of these findings was presented at the Experimental Biology Meeting (2017). Funding Information: This work was supported by National Institutes of Health (NIH) HL-098744; Merit Review Award I01CX001065 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research; NIH DK-101390; Norman S. Coplon Award, Satellite healthcare, a not-for-profit renal care provider; the Howard Hughes Medical Institute Science Education Program award #52006923 to Emory University; NIH NIDDK grant R25DK101390; Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the Howard Hughes Medical Institute or Emory University. In addition, the work was funded by and does not necessarily reflect the views of the National Institute of Health. This work was supported by National Institutes of Health (NIH) HL-098744; Merit Review Award I01CX001065 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research; NIH DK-101390; Norman S. Coplon Award, Satellite healthcare, a not-for-profit renal care provider; the Howard Hughes Medical Institute Science Education Program award #52006923 to Emory University; NIH NIDDK grant R25DK101390; Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the Howard Hughes Medical Institute or Emory University. In addition, the work was funded by and does not necessarily reflect the views of the National Institute of Health. The authors have no financial or other conflicts of interest to disclose. We gratefully acknowledge Doree Morison and Melanie Kankam for their expert assistance. An abstract presenting a preliminary version of these findings was presented at the Experimental Biology Meeting (2017). This work was supported by National Institutes of Health (NIH) HL-098744; Merit Review Award I01CX001065 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research; NIH DK-101390; Norman S. Coplon Award, Satellite healthcare, a not-for-profit renal care provider; the Howard Hughes Medical Institute Science Education Program award #52006923 to Emory University; NIH NIDDK grant R25DK101390; Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the Howard Hughes Medical Institute or Emory University. In addition, the work was funded by and does not necessarily reflect the views of the National Institute of Health. The authors have no financial or other conflicts of interest to disclose. Publisher Copyright: © 2019

PY - 2019/7

Y1 - 2019/7

N2 - Background: End stage renal disease (ESRD) is characterized by autonomic dysfunction. During orthostatic stress, sympathetic (SNS) activity increases and parasympathetic (PNS) activity decreases to maintain arterial blood pressure (BP). We hypothesized that ESRD patients have impaired ability to adjust cardiac SNS and PNS activity during orthostasis, which could contribute to increased blood pressure variability, orthostatic intolerance and falls. Methods: We measured beat-to-beat BP and Electrocardiography at baseline and during increasing lower body negative pressure (LBNP) in 20 ESRD patients and 18 matched controls (CON). Heart rate variability was quantified as total power (TP) and standard deviation of the N-N interval, reflecting both SNS and PNS; high frequency (HF), root mean square of successive differences of neighboring N-N intervals (RMSSD), and percent of consecutive N-N intervals differing >50 milliseconds (pNN50), reflecting cardiac PNS activity; and low frequency (LF) and LF/HF, reflecting sympoathovagal balance. BP variability was quantified as the standard deviation in systolic (SDSAP) and diastolic (SDDAP) BP. Results: Baseline HF, RMSSD, and pNN50 were significantly lower in ESRD (P < 0.05). While CON had a significant decrease in HF (P = 0.015), RMSSD (P = 0.003), and pNN50 (P = 0.005) during LBNP, there was no change in heart rate variability in ESRD. There was no significant difference in BP response, but ESRD had a significantly blunted heart rate response during graded LBNP compared to controls (P < 0.001). There was no significant difference in SDSAP or SDDAP during LBNP between groups (P > 0.05). Conclusions: These data suggest that ESRD patients have impaired autonomic adjustments to orthostatic stress.

AB - Background: End stage renal disease (ESRD) is characterized by autonomic dysfunction. During orthostatic stress, sympathetic (SNS) activity increases and parasympathetic (PNS) activity decreases to maintain arterial blood pressure (BP). We hypothesized that ESRD patients have impaired ability to adjust cardiac SNS and PNS activity during orthostasis, which could contribute to increased blood pressure variability, orthostatic intolerance and falls. Methods: We measured beat-to-beat BP and Electrocardiography at baseline and during increasing lower body negative pressure (LBNP) in 20 ESRD patients and 18 matched controls (CON). Heart rate variability was quantified as total power (TP) and standard deviation of the N-N interval, reflecting both SNS and PNS; high frequency (HF), root mean square of successive differences of neighboring N-N intervals (RMSSD), and percent of consecutive N-N intervals differing >50 milliseconds (pNN50), reflecting cardiac PNS activity; and low frequency (LF) and LF/HF, reflecting sympoathovagal balance. BP variability was quantified as the standard deviation in systolic (SDSAP) and diastolic (SDDAP) BP. Results: Baseline HF, RMSSD, and pNN50 were significantly lower in ESRD (P < 0.05). While CON had a significant decrease in HF (P = 0.015), RMSSD (P = 0.003), and pNN50 (P = 0.005) during LBNP, there was no change in heart rate variability in ESRD. There was no significant difference in BP response, but ESRD had a significantly blunted heart rate response during graded LBNP compared to controls (P < 0.001). There was no significant difference in SDSAP or SDDAP during LBNP between groups (P > 0.05). Conclusions: These data suggest that ESRD patients have impaired autonomic adjustments to orthostatic stress.

KW - Autonomic function

KW - Blood pressure variability

KW - End-stage renal disease (ESRD)

KW - Heart rate variability

KW - Parasympathetic activity

KW - Sympathetic activity

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Altered Autonomic Reactivity During Lower Body Negative Pressure in End-Stage Renal Disease

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Bibliographical note

Keywords

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