Avaliação do balanço autonômico cardiovascular e instrumentos de capacidade funcional de pacientes renais crônicos em hemodiálise

Abstract

Chronic kidney disease is characterized by progressive damage to renal function diagnosed through reduction of glomerular filtration rate, albuminuria, and creatinine, which, due to health problems, lead to the need for renal replacement therapy, with hemodialysis being the most common method. used. Disease progression may be associated with decreased functional capacity and dysfunction of cardiovascular autonomic control. In view of this, this study aimed to investigate the functional evaluation instruments and cardiovascular autonomic function of chronic renal patients submitted to hemodialysis. The study was divided in two parts: a systematic review of randomized clinical trials on functional evaluation with protocol elaborated and registered in PROSPERO with the number CRD42018099908, following recommendations PRISMA and Cochrane, with search carried out in PubMed, LILACS and PeDro databases and search manual, updated in November 2018. The search resulted in 2085 records, of which 25 met the inclusion criteria. The studies were published between 2000 and 2018, with the combined intervention (aerobic and resisted exercises) being used in most of the studies, and the most commonly used sit-to-stand, 6-min walk, KDQOL-SF and Timed Up and Go. The second part is a cross-sectional observational study performed at a hemodialysis clinic, approved by CEP-UFS under no. of opinion 2,594,848. The sample consisted of 58 volunteers divided into two hemodialytic (HD) (n = 29) and healthy (CO) (n = 29) groups, paired by age, gender and body mass index. Heart frequency (HR), heart rate variability (HRV) and autonomic challenges (Cold Pressor (CP) and Deep Breath (DB)) and auscultatory method for blood pressure (BP) were used. Continuous variables were expressed as mean ± standard deviation using Student's t-tests. Categorical variables used Fisher's Exact or chi-square tests for comparisons between groups. All tests considered significant p <0.05. The HD group had an increase in MBP in relation to CO during the baseline period (100.4 ± 3.0 vs 90.34 ± 1.85 mmHg; p <0.01), influenced by the difference in SBP values between the groups (139,0 ± 4,7 vs 119,1 ± 2,1 mmHg; p <0.01), however HRV did not present a significant difference. During the CP test the difference in SBP values was maintained between the groups (152.8 ± 5.9 vs. 137.1 ± 2.5 mmHg; p <0.01), although the hyperreactivity index was inversely demonstrated (p <0.01), due to the limitation of the group's physiological range HD. During the application of the DB test, a difference in ? HR can be observed (HD: 7.31 ± 0.84 vs CO: 19.62 ± 1.27 bpm; p <0.01), demonstrating the reduction of the parasympathetic response. Our results demonstrate a decrease in sympathetic and parasympathetic cardiac adjustments during autonomic challenges, demonstrating the inability of the autonomic nervous system in this population, as well as the lack of consensus regarding the instruments for the evaluation of functional capacity, performed in its largest by cardiorespiratory fitness and strength muscular.