Improved Outcomes in Hemodialysis/Hemodiafiltration Treatments Applying Exercise and Physiological Monitoring Techniques: Preliminary Results

Francisco López del Ángel; Joaquin Azpiroz Leehan, Senior Member, IEEE; Fabiola Martínez;
Emilio Sacristán Rock, Member, IEEE; Andrés Morón M; Gerardo Rosas A; Ángel Fonseca A;
Karla Quevedo, G; Ana M. De la Rosa; Miguel Cadena M, and Danilo Méndez

Abstract.End-stage renal disease affects millions of people worldwide, and the only definitive solutions are renal transplants that are not widely available. Temporary solutions are renal replacement therapies such as peritoneal dialysis, hemodialysis and hemodiafiltration. These therapies as they are applied today are just partial measures and have many drawbacks and complications such as high mortality rates and high costs due to the use of supplemental drugs and emergency room visits. Many enhancements to the therapies have been published, but they are not applied consistently in real world practice. Our work presents the results from the systematic application of several techniques to provide individualized therapies that can minimize the drawbacks and improve patient outcomes. This approach is based on the use of exercise, analysis of cardiovascular parameters, such as heart-rate variability, body composition and dry weight measurements through the use of bioimpedance and real-time monitoring of energy expenditure and nutrition intradialytically in order to provide individualized and dynamically variable therapies. Results show that patients can lead long, productive lives while maintaining a quality of life equivalent to that of a renal transplant.



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    Differences in Heart Rate Variability Between Diabetic and Non-diabetic Intradialytic Hypotensive Patients

    Francisco Arturo López del Angel, Joaquín Azpiroz Leehan, and Gerardo Daniel Rosas Andreu

    Abstract.The most frequent and troubling side effect in the treatment of hemodialysis is intradialytic hypotension (IDH). This compromises cardiovascular hemodynamics. Heart rate variability (HRV) is a non-invasive measurement of the sympathovagal balance, and provides important information about the autonomic nervous system. Few studies have compared hypotension in diabetic and non-diabetic patients throughout the therapy sessions, with a protocol of intradialytic exercise and high flux hemodialysis/hemodiafiltration therapy. Our work is aimed to evaluate cardiac autonomic regulation during hemodialysis with HRV in hemodynamically unstable patients with chronic renal disease. During a 6-month follow-up of patients, the model suggested that the sympathovagal index (LF/HF) is different between the diabetic from nondiabetic group (p < 0.05), and does not necessarily reflect the sympathetic balance. Diabetic patients were differentiated by having lower HRV power components than the non-diabetic group (p < 0.05), and during the hypotensive event they showed a sympathetic inhibition, unlike the non-diabetic group that showed a parasympathetic inhibition. It was observed that the compensatory mechanisms were markedly different between two groups studied. This study shows the importance of giving individualized attention and therapies in order to take preventive measures to avoid hypotensive events.



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