Heart Rate Variability During Hemodialysis in Patients with Chronic Renal Disease


  • Sidney Benedito Silva
  • Vitor E Valenti
  • Fernando Adami
  • Elisa Rennó Dester
  • Fernando de Souza Almeida
  • Iara Gracia Lorena
  • David . M Garner
  • Rodrigo Daminello Raimundo Scientific Writing Laboratory, Faculty of Medicine of ABC, Santo Andre, SP, Brazil
  • Rayana L. Gomes
  • Ronaldo Roberto Bergamo
  • Tatiana Dias de Carvalho
  • Luiz Carlos de Abreu




Autonomic nervous system, Cardiovascular system, Physiology, Renal dialysis.


Background: Few studies evaluated cardiac autonomic responses induced by hemodialysis. We aimed to evaluate cardiac autonomic regulation during hemodialysis in haemodynamically stable patients with chronic renal disease. Method: Heart rate variability (HRV) was analyzed in the time and frequency domains in the following periods: Pre-dialysis (10 minutes before); Hemodialysis (240 minutes). Results: The standard deviation of all normal RR intervals (SDNN) increased 60-90min after hemodialysis compared to pre-hemodialysis (29.77 ± 12ms vs. 51.70 ± 41.6ms - p<0.05). The percentage of adjacent RR intervals with a difference of duration greater than 50ms (pNN50) also raised 180-210 min after hemodialysis compared to 0-30 min after hemodialysis (1.29 ± 3.5 vs. 4.37 ± 7.8 - p<0.05). Low frequency (LF) (ms2) increased 150-180 min after hemodialysis compared to pre-hemodialysis (168.2±179.8 ms2 vs. 562.6±455.7 ms2: p<0.05) and high frequency (HF) (ms2) band raised 150-180min and 180-210 after hemodialysis compared to pre-hemodialysis (59.3 ± 70.78ms2 vs. 212.5 ± 304.9 ms2 vs. 186.3 ± 335.1 ms2: p<0.05). Conclusion: Hemodialysis acutely increased HRV, raising the parasympathetic component of  HRV.


Amerling R, Cu G, Dubrow A, et al. Complications during hemodialysis. In: Nissenson AR, Fine RN, Gentile DE (eds). Clinical Dialysis. 3rd edn. Appleton and Lange: Connecticut. 1995;242–243.

Hildreth CM. Prognostic indicators of cardiovascular risk in renal disease. Frontiers in Physiology. 2010; 2: 1-6.

Abreu LC. Heart rate variability as a functional marker of development. J Hum Growth Developm. 2012; 22:279-281.

Vanderlei LC, Pastre CM, Hoshi RA, Carvalho TD, Godoy MF. Basic notions of heart rate variability and its clinical applicability. Rev Bras Cir Cardiovasc. 2009;24(2):205-17.

Barnas MG, Boer WH, Koomans HA. Hemodynamic patterns and spectral analysis of heart rate variability during dialysis hypotension. J Am SocNephrol. 1999; 10 (12): 2577–2584.

Cavalcanti S, Severi S, Chiari L, et al. Autonomic nervous function during haemodialysis assessed by spectral analysis of heart-rate variability. ClinSci (Lond) 1997; 92: 351–359.

Runbinger D, Revis N, Pollak A, Luria MH, Saponznikov. Predictors of haemodynamic instability and heart rate variability during hemodialysis. Nerphrol Dial Transplant. 2004; 19: 2053-2060.

Moreno IL, Pastre CM, Ferreira C, de Abreu LC, Valenti VE, Vanderlei LC. Effects of an isotonic beverage on autonomic regulation during and after exercise. J IntSoc Sports Nutr. 2013; 10(1):2.

Pivatelli FC, Dos Santos MA, Fernandes GB, Gatti M, de Abreu LC, Valenti VE, et. al. Sensitivity, specificity and predictive values of linear and nonlinear indices of heart rate variability in stable angina patients. Int Arch Med. 2012; 5(1):31.

Rubinger D, Backenroth R, Sapoznikov D. Sympathetic nervous system function and dysfunction in chronic hemodialysis patients. Semin Dial. 2013; 26(3):333-43.

Sapoznikov D, Backenroth R, Rubinger D. Baroreflex sensitivity and sympatho-vagal balance during intradialytic hypotensive episodes. J Hypertens. 2010; 28(2):314–324.

Rahman F, Pechnik S, Gross D, Sewell L, Goldstein DS. Low frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation. ClinAuton Res. 2011;21(3):133-41.

Valenti VE, de Abreu LC, Imaizumi C, Petenusso M, Ferreira C. Strain differences in baroceptor reflex in adult Wistar Kyoto rats. Clinics (Sao Paulo). 2010;65(2):203-208.

Valenti VE, Abreu LC, Sato MA, Ferreira C. ATZ (3-amino-1,2,4-triazole) injected into the fourth cerebral ventricle influences the Bezold-Jarisch reflex in conscious rats. Clinics (Sao Paulo). 2010;65(12):1339-43.

Genovesi S, Bracchi O, Fabbrini P, Luisetto E, Viganò MR, Lucini D, et. al.Differences in heart rate variability during haemodialysis and haemofiltration. Nephrol Dial Transplant. 2007; 22(8):2256-62.

Yildiz A, Sever MS, Demirel S et al. Improvement of uremic autonomic dysfunction after renal transplantation: a heart rate variabilita` study. Neprhon. 1998; 80: 57–60

Low PA. Autonomic nervous system function. J ClinNeurophysiol. 1993; 10: 14–27.

Mailloux L. Hypertension in chronic renal failure and ESRD: prevalence, pathophysiology, and outcomes. SeminNephrol. 2001; 21: 146–156.

Fernandes TL, Piratello AC, Farah V, Fiorino P, Moreira ED, Irigoyen MC et al Effect of carotid and aortic baroreceptors on cardiopulmonary reflex:the role of autonomic function. Braz J Med Biol Res, 2010, 43(7) 681-686.

Ranpuria R, Hall M, Chan CT, Unruh M. Heart rate variability (HRV) in kidney failure: measurement and consequences of reduced HRV. Nephrol Dial Transplant. 2008; 23: 444–449.

Jarisch A, Zotterman Y. Depressor reflexes from the heart. Acta PhysiolScand. 1948;16:31–35.


Additional Files






Most read articles by the same author(s)

<< < 1 2 3 4 5 > >>