Baroreflex function, haemodynamic responses to an orthostatic challenge, and falls in haemodialysis patients
Stage 5 chronic kidney disease patients on haemodialysis (HD) often present with dizziness and pre-syncopal events as a result of the combined effect of HD therapy and cardiovascular disease. The dysregulation of blood pressure (BP) during orthostasis may be implicated in the aetiology of falls in t...
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| creator | Zanotto, Tobia Mercer, Thomas H van der Linden, Marietta L Traynor, Jamie P Petrie, Colin J Doyle, Arthur Chalmers, Karen Allan, Nicola Price, Jonathan Oun, Hadi Shilliday, Ilona Koufaki, Pelagia |
| description | Stage 5 chronic kidney disease patients on haemodialysis (HD) often present with dizziness and pre-syncopal events as a result of the combined effect of HD therapy and cardiovascular disease. The dysregulation of blood pressure (BP) during orthostasis may be implicated in the aetiology of falls in these patients. Therefore, we explored the relationship between baroreflex function, the haemodynamic responses to a passive orthostatic challenge, and falls in HD patients.
Seventy-six HD patients were enrolled in this cross-sectional study. Participants were classified as "fallers" and "non-fallers" and completed a passive head up tilting to 60o (HUT-60°) test on an automated tilt table. ECG signals, continuous and oscillometric BP measurements and impedance cardiography were recorded. The following variables were derived from these measurements: heart rate (HR) stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR), number of baroreceptor events, and baroreceptor effectiveness index (BEI).
The forty-four participants who were classified as fallers (57.9%) had a lower number of baroreceptor events (6.5±8.5 vs 14±16.7, p = .027) and BEI (20.8±24.2% vs 33.4±23.3%, p = .025). In addition, fallers experienced a significantly larger drop in systolic (-6.4±10.9 vs -0.4±7.7 mmHg, p = .011) and diastolic (-2.7±7.3 vs 1.8±6 mmHg, p = .027) oscillometric BP from supine to HUT-60° compared with non-fallers. None of the variables taken for the analysis were significantly associated with falls in multivariate logistic regression analysis.
This cross-sectional comparison indicates that, at rest, HD patients with a positive history of falls present with a lower count of baroreceptor sequences and BEI. Short-term BP regulation warrants further investigation as BP drops during a passive orthostatic challenge may be implicated in the aetiology of falls in HD. |
| doi_str_mv | 10.1371/journal.pone.0208127 |
| format | Article |
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Seventy-six HD patients were enrolled in this cross-sectional study. Participants were classified as "fallers" and "non-fallers" and completed a passive head up tilting to 60o (HUT-60°) test on an automated tilt table. ECG signals, continuous and oscillometric BP measurements and impedance cardiography were recorded. The following variables were derived from these measurements: heart rate (HR) stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR), number of baroreceptor events, and baroreceptor effectiveness index (BEI).
The forty-four participants who were classified as fallers (57.9%) had a lower number of baroreceptor events (6.5±8.5 vs 14±16.7, p = .027) and BEI (20.8±24.2% vs 33.4±23.3%, p = .025). In addition, fallers experienced a significantly larger drop in systolic (-6.4±10.9 vs -0.4±7.7 mmHg, p = .011) and diastolic (-2.7±7.3 vs 1.8±6 mmHg, p = .027) oscillometric BP from supine to HUT-60° compared with non-fallers. None of the variables taken for the analysis were significantly associated with falls in multivariate logistic regression analysis.
This cross-sectional comparison indicates that, at rest, HD patients with a positive history of falls present with a lower count of baroreceptor sequences and BEI. Short-term BP regulation warrants further investigation as BP drops during a passive orthostatic challenge may be implicated in the aetiology of falls in HD.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0208127</identifier><identifier>PMID: 30521545</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Accidental falls ; Accidental Falls - prevention & control ; Age ; Aged ; Analysis ; Baroreceptors ; Baroreflex - physiology ; Blood pressure ; Blood Pressure - physiology ; Cardiac output ; Cardiac Output - physiology ; Cardiography ; Cardiovascular diseases ; Chronic kidney failure ; Comorbidity ; Cross-Sectional Studies ; Diabetes ; Dizziness - diagnosis ; Dizziness - etiology ; Dizziness - physiopathology ; Echocardiography ; EKG ; Electrocardiography ; Falls ; Female ; Frailty ; Health aspects ; Heart rate ; Heart Rate - physiology ; Hemodialysis ; Hemodialysis patients ; Hemodynamic responses ; Hemodynamics ; High definition television ; Humans ; Kidney diseases ; Kidney Failure, Chronic - complications ; Kidney Failure, Chronic - physiopathology ; Kidney Failure, Chronic - therapy ; Male ; Medicine and Health Sciences ; Methods ; Middle Aged ; Older people ; Orthostatic hypotension ; Patients ; Population ; Reflexes ; Regression analysis ; Rehabilitation ; Renal Dialysis - adverse effects ; Stroke ; Stroke volume ; Stroke Volume - physiology ; Studies ; Syncope - diagnosis ; Syncope - etiology ; Syncope - physiopathology ; Tilt-Table Test ; Vascular Resistance - physiology</subject><ispartof>PloS one, 2018-12, Vol.13 (12), p.e0208127-e0208127</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Zanotto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2018 Zanotto et al 2018 Zanotto et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-46518a7d687cf57f4c979ae05f65892a015abcd0ae79e88dd9a992ce873798a83</citedby><cites>FETCH-LOGICAL-c692t-46518a7d687cf57f4c979ae05f65892a015abcd0ae79e88dd9a992ce873798a83</cites><orcidid>0000-0002-6571-4763</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283578/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283578/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30521545$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zanotto, Tobia</creatorcontrib><creatorcontrib>Mercer, Thomas H</creatorcontrib><creatorcontrib>van der Linden, Marietta L</creatorcontrib><creatorcontrib>Traynor, Jamie P</creatorcontrib><creatorcontrib>Petrie, Colin J</creatorcontrib><creatorcontrib>Doyle, Arthur</creatorcontrib><creatorcontrib>Chalmers, Karen</creatorcontrib><creatorcontrib>Allan, Nicola</creatorcontrib><creatorcontrib>Price, Jonathan</creatorcontrib><creatorcontrib>Oun, Hadi</creatorcontrib><creatorcontrib>Shilliday, Ilona</creatorcontrib><creatorcontrib>Koufaki, Pelagia</creatorcontrib><title>Baroreflex function, haemodynamic responses to an orthostatic challenge, and falls in haemodialysis patients</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Stage 5 chronic kidney disease patients on haemodialysis (HD) often present with dizziness and pre-syncopal events as a result of the combined effect of HD therapy and cardiovascular disease. The dysregulation of blood pressure (BP) during orthostasis may be implicated in the aetiology of falls in these patients. Therefore, we explored the relationship between baroreflex function, the haemodynamic responses to a passive orthostatic challenge, and falls in HD patients.
Seventy-six HD patients were enrolled in this cross-sectional study. Participants were classified as "fallers" and "non-fallers" and completed a passive head up tilting to 60o (HUT-60°) test on an automated tilt table. ECG signals, continuous and oscillometric BP measurements and impedance cardiography were recorded. The following variables were derived from these measurements: heart rate (HR) stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR), number of baroreceptor events, and baroreceptor effectiveness index (BEI).
The forty-four participants who were classified as fallers (57.9%) had a lower number of baroreceptor events (6.5±8.5 vs 14±16.7, p = .027) and BEI (20.8±24.2% vs 33.4±23.3%, p = .025). In addition, fallers experienced a significantly larger drop in systolic (-6.4±10.9 vs -0.4±7.7 mmHg, p = .011) and diastolic (-2.7±7.3 vs 1.8±6 mmHg, p = .027) oscillometric BP from supine to HUT-60° compared with non-fallers. None of the variables taken for the analysis were significantly associated with falls in multivariate logistic regression analysis.
This cross-sectional comparison indicates that, at rest, HD patients with a positive history of falls present with a lower count of baroreceptor sequences and BEI. Short-term BP regulation warrants further investigation as BP drops during a passive orthostatic challenge may be implicated in the aetiology of falls in HD.</description><subject>Accidental falls</subject><subject>Accidental Falls - prevention & control</subject><subject>Age</subject><subject>Aged</subject><subject>Analysis</subject><subject>Baroreceptors</subject><subject>Baroreflex - physiology</subject><subject>Blood pressure</subject><subject>Blood Pressure - physiology</subject><subject>Cardiac output</subject><subject>Cardiac Output - physiology</subject><subject>Cardiography</subject><subject>Cardiovascular diseases</subject><subject>Chronic kidney failure</subject><subject>Comorbidity</subject><subject>Cross-Sectional Studies</subject><subject>Diabetes</subject><subject>Dizziness - diagnosis</subject><subject>Dizziness - etiology</subject><subject>Dizziness - physiopathology</subject><subject>Echocardiography</subject><subject>EKG</subject><subject>Electrocardiography</subject><subject>Falls</subject><subject>Female</subject><subject>Frailty</subject><subject>Health aspects</subject><subject>Heart rate</subject><subject>Heart Rate - physiology</subject><subject>Hemodialysis</subject><subject>Hemodialysis patients</subject><subject>Hemodynamic responses</subject><subject>Hemodynamics</subject><subject>High definition television</subject><subject>Humans</subject><subject>Kidney diseases</subject><subject>Kidney Failure, Chronic - complications</subject><subject>Kidney Failure, Chronic - physiopathology</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Older people</subject><subject>Orthostatic hypotension</subject><subject>Patients</subject><subject>Population</subject><subject>Reflexes</subject><subject>Regression analysis</subject><subject>Rehabilitation</subject><subject>Renal Dialysis - adverse effects</subject><subject>Stroke</subject><subject>Stroke volume</subject><subject>Stroke Volume - physiology</subject><subject>Studies</subject><subject>Syncope - diagnosis</subject><subject>Syncope - etiology</subject><subject>Syncope - physiopathology</subject><subject>Tilt-Table Test</subject><subject>Vascular Resistance - physiology</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk9tq3DAQhk1padK0b1BaQ6G0kN1KtnW6KaShh4VAoKdbMZHHay9aaSPZJfv21WadsC65KLqwrPnmH81oJsteUjKnpaAfVn4IDux84x3OSUEkLcSj7JiqspjxgpSPD_ZH2bMYV4SwUnL-NDsqCSsoq9hxZj9B8AEbizd5MzjTd96d5i3g2tdbB-vO5AFjihEx5r3PweU-9K2PPfTJZlqwFt0ST5Olzpv0F_POjQId2G3sYr5JLLo-Ps-eJCLii_F7kv368vnn-bfZxeXXxfnZxcxwVfSzijMqQdRcCtMw0VRGCQVIWMOZVAUQyuDK1ARQKJSyrhUoVRiUohRKgixPstd73Y31UY-FijqlTKmqBCkTsdgTtYeV3oRuDWGrPXT69sCHpYaQErSoqeCNSLqlwKoSTQMFk1TUoiQGiVA0aX0cow1Xa6xNyjSAnYhOLa5r9dL_0byQJRO7674bBYK_HjD2et1Fg9aCQz_c3lspSSQvEvrmH_Th7EZqCSmBzjU-xTU7UX3GeMUqxSuRqPkDVFo1pmdPXdV06Xzi8H7ikJgeb_olDDHqxY_v_89e_p6ybw_YFsH2bfR22PVinILVHjTBx5i69r7IlOjdUNxVQ--GQo9DkdxeHT7QvdPdFJR_ASFeB6w</recordid><startdate>20181206</startdate><enddate>20181206</enddate><creator>Zanotto, Tobia</creator><creator>Mercer, Thomas H</creator><creator>van der Linden, Marietta L</creator><creator>Traynor, Jamie P</creator><creator>Petrie, Colin J</creator><creator>Doyle, Arthur</creator><creator>Chalmers, Karen</creator><creator>Allan, Nicola</creator><creator>Price, Jonathan</creator><creator>Oun, Hadi</creator><creator>Shilliday, Ilona</creator><creator>Koufaki, Pelagia</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-6571-4763</orcidid></search><sort><creationdate>20181206</creationdate><title>Baroreflex function, haemodynamic responses to an orthostatic challenge, and falls in haemodialysis patients</title><author>Zanotto, Tobia ; Mercer, Thomas H ; van der Linden, Marietta L ; Traynor, Jamie P ; Petrie, Colin J ; Doyle, Arthur ; Chalmers, Karen ; Allan, Nicola ; Price, Jonathan ; Oun, Hadi ; Shilliday, Ilona ; Koufaki, Pelagia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-46518a7d687cf57f4c979ae05f65892a015abcd0ae79e88dd9a992ce873798a83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Accidental falls</topic><topic>Accidental Falls - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zanotto, Tobia</au><au>Mercer, Thomas H</au><au>van der Linden, Marietta L</au><au>Traynor, Jamie P</au><au>Petrie, Colin J</au><au>Doyle, Arthur</au><au>Chalmers, Karen</au><au>Allan, Nicola</au><au>Price, Jonathan</au><au>Oun, Hadi</au><au>Shilliday, Ilona</au><au>Koufaki, Pelagia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Baroreflex function, haemodynamic responses to an orthostatic challenge, and falls in haemodialysis patients</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-12-06</date><risdate>2018</risdate><volume>13</volume><issue>12</issue><spage>e0208127</spage><epage>e0208127</epage><pages>e0208127-e0208127</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Stage 5 chronic kidney disease patients on haemodialysis (HD) often present with dizziness and pre-syncopal events as a result of the combined effect of HD therapy and cardiovascular disease. The dysregulation of blood pressure (BP) during orthostasis may be implicated in the aetiology of falls in these patients. Therefore, we explored the relationship between baroreflex function, the haemodynamic responses to a passive orthostatic challenge, and falls in HD patients.
Seventy-six HD patients were enrolled in this cross-sectional study. Participants were classified as "fallers" and "non-fallers" and completed a passive head up tilting to 60o (HUT-60°) test on an automated tilt table. ECG signals, continuous and oscillometric BP measurements and impedance cardiography were recorded. The following variables were derived from these measurements: heart rate (HR) stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR), number of baroreceptor events, and baroreceptor effectiveness index (BEI).
The forty-four participants who were classified as fallers (57.9%) had a lower number of baroreceptor events (6.5±8.5 vs 14±16.7, p = .027) and BEI (20.8±24.2% vs 33.4±23.3%, p = .025). In addition, fallers experienced a significantly larger drop in systolic (-6.4±10.9 vs -0.4±7.7 mmHg, p = .011) and diastolic (-2.7±7.3 vs 1.8±6 mmHg, p = .027) oscillometric BP from supine to HUT-60° compared with non-fallers. None of the variables taken for the analysis were significantly associated with falls in multivariate logistic regression analysis.
This cross-sectional comparison indicates that, at rest, HD patients with a positive history of falls present with a lower count of baroreceptor sequences and BEI. Short-term BP regulation warrants further investigation as BP drops during a passive orthostatic challenge may be implicated in the aetiology of falls in HD.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30521545</pmid><doi>10.1371/journal.pone.0208127</doi><tpages>e0208127</tpages><orcidid>https://orcid.org/0000-0002-6571-4763</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2018-12, Vol.13 (12), p.e0208127-e0208127 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2151194703 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Accidental falls Accidental Falls - prevention & control Age Aged Analysis Baroreceptors Baroreflex - physiology Blood pressure Blood Pressure - physiology Cardiac output Cardiac Output - physiology Cardiography Cardiovascular diseases Chronic kidney failure Comorbidity Cross-Sectional Studies Diabetes Dizziness - diagnosis Dizziness - etiology Dizziness - physiopathology Echocardiography EKG Electrocardiography Falls Female Frailty Health aspects Heart rate Heart Rate - physiology Hemodialysis Hemodialysis patients Hemodynamic responses Hemodynamics High definition television Humans Kidney diseases Kidney Failure, Chronic - complications Kidney Failure, Chronic - physiopathology Kidney Failure, Chronic - therapy Male Medicine and Health Sciences Methods Middle Aged Older people Orthostatic hypotension Patients Population Reflexes Regression analysis Rehabilitation Renal Dialysis - adverse effects Stroke Stroke volume Stroke Volume - physiology Studies Syncope - diagnosis Syncope - etiology Syncope - physiopathology Tilt-Table Test Vascular Resistance - physiology |
| title | Baroreflex function, haemodynamic responses to an orthostatic challenge, and falls in haemodialysis patients |
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