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2016 ; 16
(1
): 210
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Association between autonomic nervous dysfunction and cellular inflammation in
end-stage renal disease
#MMPMID27809785
Seibert E
; Zohles K
; Ulrich C
; Kluttig A
; Nuding S
; Kors JA
; Swenne CA
; Werdan K
; Fiedler R
; Girndt M
BMC Cardiovasc Disord
2016[Nov]; 16
(1
): 210
PMID27809785
show ga
BACKGROUND: Alterations in autonomic nervous function are common in hemodialysis
(HD) patients. Sympathetic as well as parasympathetic activation may be
associated with immune and inflammatory responses. We intended to confirm a role
of autonomous dysregulation for inflammation in HD patients. METHODS: 30 HD
patients (including 15 diabetics) and 15 healthy controls were studied for heart
rate variability (HRV) using 5 min ECG recordings. Heart rate variability was
estimated by time-domain parameters (the standard deviation of the RR intervals
(SDNN) and the percentage of pairs of adjacent RR intervals differing by >50 ms
(pNN50)) and frequency-domain-analysis (high- and low-frequency variation of RR
intervals, HF and LF). Inflammation was detected as serum C-reactive Protein
(CRP), IL-6 and circulating monocyte subpopulation numbers. Immune cells were
characterized by ACh receptor expression. RESULTS: Patients differed from
controls in terms of age (68.0 [14.8] yrs vs. 58.0 [13.0] yrs, p?0.001; Median
[IQR]) and sex. However, HRV parameters were different in controls and HD
patients (SDNN controls 34.0 [14.0] ms, HD patients 15.5 [14.8] ms, p?0.01).
This finding was not restricted to patients with diabetes mellitus (diab),
although diabetes is an important cause of autonomous dysfunction (SDNN, diab
13.0 [14.0] ms, non-diab 18.0 [15.3] ms, p?=?0.8). LF and HF were reduced by the
same magnitude to 1/3 of those in controls. Patients suffered from chronic
inflammation (CRP 9.4 [12.9] mg/l, controls 1.6 [2.4] mg/l, p?0.001) and
expanded proinflammatory monocyte subpopulations (CD14++/CD16+ cells: patients 41
[27]/?l, controls 24 [18]/?l, p?0.01). ECG parameters did not correlate with
inflammation in patients, but monocyte ACh receptor expression was enhanced,
indicating potentially elevated responsiveness of this cell type to
parasympathetic regulation. CONCLUSIONS: HD patients have strongly impaired HRV.
Chronic inflammation is not related to autonomous dysfunction, although monocytes
express the ACh receptor at enhanced density making them potentially more
sensitive to parasympathetic effects. TRIAL REGISTRATION: This study was listed
with ClinicalTrials.gov ( NCT00878033 ).