- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05278702
Autonomic Nervous System Dysfunction in Patients With End-stage Kidney Disease
Study Overview
Status
Conditions
Detailed Description
This is an observational study performed in the Department of Nephrology, Hippokration Hospital, Thessaloniki, Greece. For the purposes of this study, adult patients (>18 years) with ESKD being treated with hemodialysis (HD) (on standard thrice-weekly HD treatment) or peritoneal dialysis (PD) for at least 3 months, fulfilling the inclusion/exclusion criteria were invited to participate. PD and HD patients will be matched by a blinded member of our team based on age, gender and dialysis vintage (i.e. the duration of time after the point they started renal replacement therapy for ESRD) in a 1:1 ratio. All included patients signed a written informed consent form. The study protocol was approved by the Ethics Committee of the School of Medicine, Aristotle University of Thessaloniki. All procedures and evaluations are performed according to the Declaration of Helsinki 2013 Amendment.
Evaluation of participants includes the recording of demographics and anthropometric characteristics, medical history, concomitant medications and dialysis-related parameters, as well as physical examination and venous blood sampling for routine laboratory tests. Participants are instructed to visit the Department one hour before the programmed follow-up visit at their unit (PD patients); HD patients are instructed to visit the Department on 2 consecutive days (mid-week dialysis day and the corresponding dialysis-off day). All procedures are performed in a room with an ambient temperature of 23-24oC. Firstly, participants are oriented and familiarized with the experimental procedures and are prepared for the hemodynamic and cardiovascular examinations. Continuous beat-by-beat BP and heart rate are monitored using finger photoplethysmography (Finometer PRO, Finapres Medical Systems, Amsterdam, the Netherlands) throughout the protocol. An inflatable cuff is placed on the middle finger of the non-access hand maintained at heart level. After a 5-min rest, all participants underwent a mental task (countdown from 100 to 0 by 7, performed twice), an orthostatic test (5 min with the patient at the supine position followed by 5 min with the patient in upright position), and a mild physical task [3-minute submaximal handgrip exercise test (set of 30 s exercise at 35% MVC with 3 s rest] (K-Force, K-invent). At the completion of the exercise protocol, the Rate of Perceived Exertion (RPE) is assessed using the Borg scale.
For data analysis, beat-by-beat SBP and DBP will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands). From pulse pressure profiles, beat-by-beat heart rate (HR) and stroke volume (SV, ml) will be computed, using the Modelflow method; cardiac output (L/min) and systemic vascular resistance (SVR, mmHg.s/mL), will also be computed using Beatscope. HRV analysis will be performed with the HRV Analysis software Kubios (version 3.3.1, Kubios Oy, 2019) by the same researcher to eliminate inter-observer variability. R-R interval series will be checked for ectopic beats or artifacts. The root mean square of successive differences (RMSSD) between the coupling intervals of adjacent R-R intervals will be used as a parasympathetic activity index. Baroreceptor sensitivity (ms/mmHg) will be assessed by examining the spontaneous fluctuations in the blood pressure as assessed by the cross-correlation method using the Beatscope 1a software).
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Contact
- Name: Danai Faitatzidou
- Phone Number: +302313312930
- Email: d.a.n.a.i.90@hotmail.com
Study Contact Backup
- Name: Pantelis Sarafidis
- Phone Number: +302313312930
- Email: psarafidis11@yahoo.gr
Study Locations
-
-
-
Thessaloniki, Greece, 54642
- Recruiting
- Department of Nephrology, Hippokration Hospital
-
Contact:
- Danai Faitatzidou
- Phone Number: +302313312930
- Email: d.a.n.a.i.90@hotmail.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Age >18 years
- ESKD individuals treated with either hemodialysis (standard thrice weekly schedule) or peritoneal dialysis for at least 3 months
- Provision of informed written consent
Exclusion Criteria:
- Antihypertensive treatment modifcation during one month prior to study enrollment
- Modification of treatment for neurological disorders one month prior to study enrollment
- Active malignant disease or other comorbidity with poor prognosis
- History of neurological disorders (e.g. Parkinson's disease, multiple sclerosis, etc) that cause primary ANS dysfunction
- History of ANS dysfunction secondary to diabetes mellitus, amyloidosis, autoimmune disorders, etc.
- Active infection or relevant inter-current illness.
- History of drug or alcohol abuse or severe mental disorder
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
---|
hemodialysis
|
peritoneal dialysis
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The difference in the root mean square of successive R-R differences [RMSSD (ms)] parameter of heart rate variability during the mental arithmetic test between the examination during the dialysis session and the examination in the out-of-dialysis day
Time Frame: Baseline
|
The root mean square of successive differences (RMSSD) between the coupling intervals of adjacent R-R intervals will be used as a parasympathetic activity index.
RMSSD will be calculated with the HRV Analysis software Kubios (version 3.3.1,
Kubios Oy, 2019)
|
Baseline
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The difference in baroreceptor-sensitivity (ms/mmHg) during mental-arithmetic-test between examination during the session and examination in the out-of-dialysis day.
Time Frame: Baseline
|
Baroreceptor sensitivity (ms/mmHg) will be assessed by examining the spontaneous fluctuations in the blood pressure as assessed by the cross-correlation method using the Beatscope 1a software).
|
Baseline
|
The difference in stroke-volume (ml) during mental-arithmetic-test between examination during the session and examination in the out-of-dialysis day.
Time Frame: Baseline
|
Beat-by-beat stroke volume (ml) will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in cardiac-output (L/min) during mental-arithmetic-test between examination during the session and examination in the out-of-dialysis day
Time Frame: Baseline
|
Beat-by-beat cardiac output (L/min) will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands).
|
Baseline
|
The difference in total-peripheral-resistance during mental-arithmetic-test between examination during the session and examination in the out-of-dialysis day.
Time Frame: Baseline
|
Beat-by-beat total peripheral resistance (mmHg.s/mL)
will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in both SBP and DBP (mmHg) during mental-arithmetic-test between examination during the session and examination in the out-of-dialysis day.
Time Frame: Baseline
|
Beat-by-beat SBP and DBP will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in in the root mean square of successive R-R differences [RMSSD (ms)] parameter of heart rate variability during the handgrip test between dialysis session start and session end.
Time Frame: Baseline
|
The root mean square of successive differences (RMSSD) between the coupling intervals of adjacent R-R intervals will be used as a parasympathetic activity index.
RMSSD will be calculated with the HRV Analysis software Kubios (version 3.3.1,
Kubios Oy, 2019)
|
Baseline
|
The difference in baroreceptor sensitivity (ms/mmHg) during the handgrip test between dialysis session start and session end.
Time Frame: Baseline
|
Baroreceptor sensitivity (ms/mmHg) will be assessed by examining the spontaneous fluctuations in the blood pressure as assessed by the cross-correlation method using the Beatscope 1a software).
|
Baseline
|
The difference in cardiac output (L/min) during the handgrip test between dialysis session start and session end.
Time Frame: Baseline
|
Beat-by-beat cardiac output (L/min) will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in total peripheral resistance during the handgrip test between dialysis session start and session end.
Time Frame: Baseline
|
Beat-by-beat total peripheral resistance (mmHg.s/mL)
will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in both SBP and DBP (mmHg) during the handgrip test between dialysis session start and session end.
Time Frame: Baseline
|
Beat-by-beat SBP and DBP will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in stroke volume (ml) during the handgrip test between dialysis session start and session end.
Time Frame: Baseline
|
Beat-by-beat stroke volume (ml) will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in in the root mean square of successive R-R differences [RMSSD (ms)] parameter of heart rate variability during the orthostatic test between dialysis session start and session end
Time Frame: Baseline
|
The root mean square of successive differences (RMSSD) between the coupling intervals of adjacent R-R intervals will be used as a parasympathetic activity index.
RMSSD will be calculated with the HRV Analysis software Kubios (version 3.3.1,
Kubios Oy, 2019)
|
Baseline
|
The difference in baroreceptor sensitivity (ms/mmHg) during the orthostatic test between dialysis session start and session end.
Time Frame: Baseline
|
Baroreceptor sensitivity (ms/mmHg) will be assessed by examining the spontaneous fluctuations in the blood pressure as assessed by the cross-correlation method using the Beatscope 1a software).
|
Baseline
|
The difference in stroke volume (ml) during the orthostatic test between dialysis session start and session end.
Time Frame: Baseline
|
Beat-by-beat stroke volume (ml) will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in cardiac output (L/min) during the orthostatic test between dialysis session start and session end.
Time Frame: Baseline
|
Beat-by-beat cardiac output (L/min) will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in the total peripheral resistance during the orthostatic test between dialysis session start and session end.
Time Frame: Baseline
|
Beat-by-beat total peripheral resistance (mmHg.s/mL)
will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in both SBP and DBP (mmHg) during the orthostatic test between dialysis session start and session end.
Time Frame: Baseline
|
Beat-by-beat SBP and DBP will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in in the root mean square of successive R-R differences [RMSSD (ms)] parameter of heart rate variability during the handgrip test between hemodialysis and peritoneal dialysis patients:.
Time Frame: Baseline
|
The root mean square of successive differences (RMSSD) between the coupling intervals of adjacent R-R intervals will be used as a parasympathetic activity index.
RMSSD will be calculated with the HRV Analysis software Kubios (version 3.3.1,
Kubios Oy, 2019)
|
Baseline
|
The difference in the baroreceptor sensitivity (ms/mmHg) during the handgrip test between hemodialysis and peritoneal dialysis patients:.
Time Frame: Baseline
|
Baroreceptor sensitivity (ms/mmHg) will be assessed by examining the spontaneous fluctuations in the blood pressure as assessed by the cross-correlation method using the Beatscope 1a software).
|
Baseline
|
The difference in the stroke volume (ml) during the handgrip test between hemodialysis and peritoneal dialysis patients:.
Time Frame: Baseline
|
Beat-by-beat stroke volume (ml) will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in the total peripheral resistance during the handgrip test between hemodialysis and peritoneal dialysis patients:.
Time Frame: Baseline
|
Beat-by-beat total peripheral resistance (mmHg.s/mL)
will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in the cardiac output (L/min) during the handgrip test between hemodialysis and peritoneal dialysis patients.
Time Frame: Baseline
|
Beat-by-beat cardiac output (L/min) will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in both SBP and DBP (mmHg) during the handgrip test between hemodialysis and peritoneal dialysis patients.
Time Frame: Baseline
|
Beat-by-beat SBP and DBP will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in in the root mean square of successive R-R differences [RMSSD (ms)] parameter of heart rate variability during the orthostatic test between hemodialysis and peritoneal dialysis patients.
Time Frame: Baseline
|
The root mean square of successive differences (RMSSD) between the coupling intervals of adjacent R-R intervals will be used as a parasympathetic activity index.
RMSSD will be calculated with the HRV Analysis software Kubios (version 3.3.1,
Kubios Oy, 2019)
|
Baseline
|
The difference in baroreceptor sensitivity (ms/mmHg) during the orthostatic test between hemodialysis and peritoneal dialysis patients.
Time Frame: Baseline
|
Baroreceptor sensitivity (ms/mmHg) will be assessed by examining the spontaneous fluctuations in the blood pressure as assessed by the cross-correlation method using the Beatscope 1a software).
|
Baseline
|
The difference in cardiac output (L/min) during the orthostatic test between hemodialysis and peritoneal dialysis patients.
Time Frame: Baseline
|
Beat-by-beat cardiac output (L/min) will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in total peripheral resistance during the orthostatic test between hemodialysis and peritoneal dialysis patients.
Time Frame: Baseline
|
Beat-by-beat total peripheral resistance (mmHg.s/mL)
will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in stroke volume (ml) during the orthostatic test between hemodialysis and peritoneal dialysis patients.
Time Frame: Baseline
|
Beat-by-beat stroke volume (ml) will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
The difference in both SBP and DBP (mmHg) during the orthostatic test between hemodialysis and peritoneal dialysis patients.
Time Frame: Baseline
|
Beat-by-beat SBP and DBP will be averaged per testing session and exported using the Beatscope software (version 1.a, Finapres Medical Systems, Amsterdam, the Netherlands)
|
Baseline
|
Collaborators and Investigators
Publications and helpful links
General Publications
- Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996 Mar 1;93(5):1043-65. No abstract available.
- Savica V, Musolino R, Di Leo R, Santoro D, Vita G, Bellinghieri G. Autonomic dysfunction in uremia. Am J Kidney Dis. 2001 Oct;38(4 Suppl 1):S118-21. doi: 10.1053/ajkd.2001.27418.
- Kamal A. Effect of hemodialysis on autonomic dysfunction in patients with chronic renal failure - biomed 2009. Biomed Sci Instrum. 2009;45:280-5.
- Galiatsatos P, Parakh K, Monti J, Thavarajah S, Aneke-Ogbu H, Watson A, Kim D, Wang NY, Shafi T, Silber HA. A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis. BMC Nephrol. 2015 Aug 14;16:138. doi: 10.1186/s12882-015-0135-0.
- Parati G, Casadei R, Groppelli A, Di Rienzo M, Mancia G. Comparison of finger and intra-arterial blood pressure monitoring at rest and during laboratory testing. Hypertension. 1989 Jun;13(6 Pt 1):647-55. doi: 10.1161/01.hyp.13.6.647.
- Dipla K, Kousoula D, Zafeiridis A, Karatrantou K, Nikolaidis MG, Kyparos A, Gerodimos V, Vrabas IS. Exaggerated haemodynamic and neural responses to involuntary contractions induced by whole-body vibration in normotensive obese versus lean women. Exp Physiol. 2016 Jun 1;101(6):717-30. doi: 10.1113/EP085556.
- Westerhof BE, Gisolf J, Stok WJ, Wesseling KH, Karemaker JM. Time-domain cross-correlation baroreflex sensitivity: performance on the EUROBAVAR data set. J Hypertens. 2004 Jul;22(7):1371-80. doi: 10.1097/01.hjh.0000125439.28861.ed.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- ΔΔ4844
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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