Circadian Variation of Death in Hemodialysis Patients

Tislér, András; Logan, Alexander G.; Akócsi, Katalin; Tornóci, László; Kiss, István

doi:10.1053/j.ajkd.2007.09.019

Cited by 10 publications

(7 citation statements)

References 25 publications

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“…Circadian blood pressure variation is compromised in patients with advanced CKD (stages 3-5) (Elung-Jensen et al, 2008). The mortality of CKD patients also follows a circadian variation with increased rate of death in the morning (Tisler et al, 2008). We have shown that CKD patients under regular evening hemodialysis had better sleep quality and less daytime sleepiness compared with those under morning and afternoon shifts (Hsu et al, 2008).…”

Section: Introductionmentioning

confidence: 82%

“…The endogenous rhythm of the most important circadian hormone in human body is melatonin which is impaired in patients with CKD and relates to the degree of disease (Koch et al, 2010). The mortality of dialysis patients tends to happen in the morning (Tisler et al, 2008). This phenomenon could be partially explained by the variation of circadian blood pressure (Elung-Jensen et al, 2008).…”

Section: Ckd Ratsmentioning

confidence: 99%

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Disrupted circadian rhythm in rats with nephrectomy-induced chronic kidney disease

Hsu

Chang

et al. 2012

Life Sciences

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Section: Introductionmentioning

confidence: 82%

Section: Ckd Ratsmentioning

confidence: 99%

Disrupted circadian rhythm in rats with nephrectomy-induced chronic kidney disease

Hsu

Chang

et al. 2012

Life Sciences

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“…This may result renin-angiotensin system activation and possibly lead to sudden cardiac death in the early morning. 17) Theoretically, inhibiting sympathetic activity could improve CKD patient outcomes, similar to patients with heart failure. The dissociation between the hypothesis and current clinical practice suggests that autonomic function response to βblockers may be different between CKD and non-CKD patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of Sympatholytic Therapy on Circadian Cardiac Autonomic Activity in Non-Diabetic Chronic Kidney Disease

et al. 2018

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Although beta-blockade itself is not a first choice for chronic kidney disease (CKD) patients, alpha-betablockers (ABB) do improve their prognoses. This study's aim was to evaluate the effect of beta-selectiveblockers (BSB) and ABB on circadian cardiac autonomic activity in CKD patients. The study consisted of 496 non-diabetic individuals who underwent 24-hour Holter monitoring (149 CKD patients and 347 controls without CKD). Using heart rate variability analysis, we evaluated the proportion of NN50 and the high-frequency component (reflecting parasympathetic activity), and low-to high-frequency ratio (reflecting sympathovagal balance). These indices were evaluated by regression analysis incorporating gender, age, related comorbidities, and medications. BSB increased vagal activity only in the daytime and not the night-time in controls. In CKD patients, BSB was significantly related to higher vagal activity throughout the day and with lower sympathovagal balance at night. The night sympathovagal balance of CKD patients taking ABB was significantly higher than that of CKD patients taking BSB, which was the only significant difference between the effects of BSB and ABB. The sympatholytic therapy effect is different depending on CKD presence and whether patients are treated with BSB or ABB. In CKD patients without severe heart failure, BSB could be associated with higher parasympathetic activity and lower sympathovagal balance compared to ABB.

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“…In addition to physiological rhythms, there also appears to be a circadian pattern in the risk of death in dialysis patients. In a study in 459 dialysis patients, morning death occurred 25% more often than expected [23]. While the exact reasons remain to be elucidated, the morning surge in catecholamines may be involved.…”

Section: Circadian Patternsmentioning

confidence: 95%

Cycles, Arrows and Turbulence: Time Patterns in Renal Disease, a Path from Epidemiology to Personalized Medicine?

et al. 2018

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Patients with end-stage renal disease (ESRD) experience unique patterns in their lifetime, such as the start of dialysis and renal transplantation. In addition, there is also an intricate link between ESRD and biological time patterns. In terms of cyclic patterns, the circadian blood pressure (BP) rhythm can be flattened, contributing to allostatic load, whereas the circadian temperature rhythm is related to the decline in BP during hemodialysis (HD). Seasonal variations in BP and interdialytic-weight gain have been observed in ESRD patients in addition to a profound relative increase in mortality during the winter period. Moreover, nonphysiological treatment patters are imposed in HD patients, leading to an excess mortality at the end of the long interdialytic interval. Recently, new evidence has emerged on the prognostic impact of trajectories of common clinical and laboratory parameters such as BP, body temperature, and serum albumin, in addition to single point in time measurements. Backward analysis of changes in cardiovascular, nutritional, and inflammatory parameters before the occurrence as hospitalization or death has shown that changes may already occur within months to even 1–2 years before the event, possibly providing a window of opportunity for earlier interventions. Disturbances in physiological variability, such as in heart rate, characterized by a loss of fractal patterns, are associated with increased mortality. In addition, an increase in random variability in different parameters such as BP and sodium is also associated with adverse outcomes. Novel techniques, based on time-dependent analysis of variability and trends and interactions of multiple physiological and laboratory parameters, for which machine-learning approaches may be necessary, are likely of help to the clinician in the future. However, upcoming research should also evaluate whether dynamic patterns observed in large epidemiological studies have relevance for the individual risk profile of the patient.

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Circadian Variation of Death in Hemodialysis Patients

Cited by 10 publications

References 25 publications

Disrupted circadian rhythm in rats with nephrectomy-induced chronic kidney disease

Disrupted circadian rhythm in rats with nephrectomy-induced chronic kidney disease

Effect of Sympatholytic Therapy on Circadian Cardiac Autonomic Activity in Non-Diabetic Chronic Kidney Disease

Cycles, Arrows and Turbulence: Time Patterns in Renal Disease, a Path from Epidemiology to Personalized Medicine?

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