Original Paper

Effect of Dialysate Temperature and Diabetes on Autonomic Cardiovascular Regulation during Hemodialysis
Emanuel Zitt^a, Ulrich Neyer^{b, c}, Edgar Meusburger^b, Martin Tiefenthaler^a, Peter Kotanko^d, Gert Mayer^a, Alexander R. Rosenkranz<sup>a

a</sup>Clinical Division of Nephrology, Department of Internal Medicine, Innsbruck Medical University, Innsbruck,
^bDepartment of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, and
^cVIVIT, Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, and
^dDepartment of Internal Medicine, Krankenhaus der Barmherzigen Brüder, Teaching Hospital, Medical University Graz, Graz, Austria

Address of Corresponding Author

Kidney Blood Press Res 2008;31:217-225 (DOI: 10.1159/000141926)

  Key Words

• Autonomic function
• Diabetes mellitus
• Hemodialysis
• Dialysate temperature
• Heart rate variability
• Power spectral analysis

  Abstract

Background/Aims: Lowering dialysate temperature to increase intradialytic hemodynamic stability may interfere with the ultrafiltration-dependent intradialytic autonomic cardiovascular regulation. The present study aimed to investigate hemodynamic and autonomic responses depending on dialysate temperature and the presence of diabetes. Methods: Seventeen (8 diabetic, 9 non-diabetic) hypotension-resistant patients were alternately treated at dialysate temperatures of 37 and 35°C. Hemodynamic parameters, heart rate variability (HRV) and baroreceptor reflex sensitivity (BRRS) were measured noninvasively. Power spectral analysis of HRV was used to evaluate cardiac sympathetic and parasympathetic activity. Results: In contrast to diabetic patients who showed an overall reduced autonomic activity and a blunted autonomic response, in non-diabetic patients cardiac sympathetic activity increased during dialysis (p < 0.05) resulting in a shift in sympathovagal balance towards sympathetic predominance. This response was not altered by dialysate temperature. Significant decreases in stroke volume and cardiac output were found in both patient groups. Total peripheral resistance increased in diabetic (p < 0.05) and in non-diabetic patients (p < 0.01) at both dialysate temperatures. No differences in BRRS were determined. Conclusion: The presence of diabetes has great impact on the cardiovascular autonomic regulation during hemodialysis. Varying the dialysate temperature does not influence cardiovascular autonomic regulation in hemodynamically stable diabetic and non-diabetic patients.

Copyright © 2008 S. Karger AG, Basel

  Author Contacts

Alexander R. Rosenkranz, Clinical Division of Nephrology
Clinical Department of Internal Medicine, Innsbruck Medical University
Anichstrasse 35, AT-6020 Innsbruck (Austria)
Tel. +43 512 504 81333, Fax +43 512 504 23309
E-Mail alexander.rosenkranz@i-med.ac.at

  Article Information

Received: December 3, 2007
Accepted: May 8, 2008
Published online: June 28, 2008
Number of Print Pages : 9
Number of Figures : 1, Number of Tables : 5, Number of References : 31