Clinical significance of heart rate variability for the monitoring of cardiac autonomic neuropathy in end-stage renal disease patients

Min, Ji Won; Chang, Ji-Yeun; Lee, Hanbi; Park, Yohan; Ko, Eun Jeong; Cho, Jae Hyoung; Yang, Chul Woo; Chung, Byung Ha

doi:10.1016/j.numecd.2021.03.016

Cited by 4 publications

(2 citation statements)

References 45 publications

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“…This mismatch between abnormal SPECT results and angiographic findings limits the utility of SPECT as a CAD screening tool in ESKD patients. It has been hypothesised that abnormal SPECT results may represent true subendocardial ischaemia without coronary artery stenosis which in turn correlates with MACE outcomes [ 243 , 244 ].…”

Section: Non-invasive Testingmentioning

confidence: 99%

The Controversies of Coronary Artery Disease in End-Stage Kidney Disease Patients: A Narrative Review

Hirsch¹,

Lau²,

Kushwaha³

et al. 2023

Rev. Cardiovasc. Med.

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Cardiovascular disease (CVD) accounts for more than 50% of deaths among patients with end-stage kidney disease (ESKD). Approximately 40–50% of ESKD patients have clinically significant coronary artery disease (CAD) due to atherosclerosis which accounts for a significant proportion of CVD risk. However, other CVD pathologies including myocardial fibrosis, vascular calcification and arterial stiffening play important contributory roles. The pathophysiology of CAD in ESKD is distinct from the general population. ESKD patients is typically have diffuse multi-vessel involvement with increased calcification that involves both intimal and medial layers of the arterial wall. There is a complex interplay between an increased burden of traditional Framingham risk factors and exposure to non-traditional risk factors including chronic inflammation and dialysis per se . Established treatments for CAD risk factors including cholesterol lowering with statin therapy have attenuated effects and ESKD patients also have worse outcomes after revascularisation. Recent trials such as the Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS) have established that direct modulation of inflammation improves CVD outcomes in the general population, which may prove to be a potential attractive therapeutic target in ESKD patients. Multiple retrospective observational studies comparing mortality outcomes between haemodialysis (HD) and peritoneal dialysis (PD) patients have been inconclusive. Randomised trials on this issue of clinical equipoise are clearly warranted but are unlikely to be feasible. Screening for stable CAD in asymptomatic ESKD patients remains a clinical dilemma which is unique to chronic dialysis patients being assessed for kidney transplantation. This has become particularly relevant in light of the recent ISCHEMIA-CKD trial which demonstrated no difference between optimal medical therapy and revascularisation upon CVD outcomes or mortality. The optimal strategy for screening is currently being investigated in the ongoing large international multi-centre CARSK trial. Here we discuss the pathophysiology, risk modification, treatment, screening and future directions of CAD in ESKD.

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Section: Non-invasive Testingmentioning

confidence: 99%

The Controversies of Coronary Artery Disease in End-Stage Kidney Disease Patients: A Narrative Review

Hirsch¹,

Lau²,

Kushwaha³

et al. 2023

Rev. Cardiovasc. Med.

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“…22 Numerous studies have validated HRV as a reliable measure of ANS function in cardiac and non-cardiac diseases. [23][24][25][26] By analyzing HRV of POAG, the researchers found that patients with POAG had autonomic dysfunction and the ANS dysfunction in POAG was characterized by reduced HRV. [12][13][14] However, the study on how ANS dysfunction characterized by low HRV affected glaucoma progression in POAG was defective.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Autonomic Nervous System Dysfunction on the Progression of Primary Open-Angle Glaucoma

Liu¹,

Zhao²,

Zhang³

2022

IJGM

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To study the effect of autonomic nervous system (ANS) dysfunction on glaucoma progression in patients with primary open angle glaucoma (POAG). Patients and Methods: A retrospective study of 40 cases of POAG patients who underwent regular reexamination for more than 3 years was performed. All participants were subjected to heart-rate variability (HRV) assessment. Patients were divided equally into the lowest and highest HRV groups according to the standard deviation value of the qualified normal to normal intervals (SDNN), a representative indicator of HRV. The lower the HRV, the more severe the ANS dysfunction with sympathetic predominance. Visual field (VF) parameters and retinal nerve fiber layer (RNFL) thickness were used to evaluate and compare the progression of glaucoma damage between the two groups. Results: There were 20 cases in the lowest HRV group and 20 cases in the highest HRV group. The thinning rate of RNFL in the lowest HRV group was significantly faster than that in the highest HRV group (1.44±1.58 vs 0.29±0.56 μm/year, P=0.00), accompanied by greater fluctuation of intraocular pressure (IOP) (P=0.04), lower diastolic blood pressure (P=0.01), mean blood pressure (P=0.04), and lower mean ocular perfusion pressure (P=0.04). Meanwhile, the incidence of central VF defects in the lowest HRV group was significantly higher than that in the highest HRV group (65.0% vs 30%, P=0.03). Linear regression analysis showed that there was a significant correlation between SDNN and the thickness loss rate of RNFL (P=0.01). Conclusion: POAG patients with lower HRV, which reflects ANS dysfunction with sympathetic predominance, presented faster glaucoma progression than patients with higher HRV. The more rapid progression of POAG with lower HRV may be explained by IOP and vascular risk factors.

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Usefulness of the heart rate variability test in predicting intradialytic hypotension in patients undergoing chronic haemodialysis

Park,

Lee,

Yoon

et al. 2024

Clinical Kidney Journal

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Background Intradialytic hypotension (IDH) is the primary complication of haemodialysis; however, its diverse pathophysiology and inconsistent definitions complicate its prediction. Despite using the heart rate variability (HRV) test for IDH prediction, studies on its usefulness for predicting IDH diagnosed per the nadir 90 criterion are lacking. We aimed to evaluate HRV test efficacy and reproducibility in predicting IDH diagnosis based on the nadir 90 criterion. Methods Seventy patients undergoing haemodialysis participated in this multicentre prospective observational study. The HRV test was performed during non-haemodialysis periods, and IDH was monitored during 12 haemodialysis sessions. IDH was diagnosed according to the nadir 90 criterion, defined as a decrease in systolic blood pressure of ≤90 mmHg during haemodialysis. After monitoring, the HRV test was repeated. An HRV–IDH index was developed using multivariate logistic regression analysis employing HRV test parameters. The predictive power of the HRV–IDH index was analysed using the area under the receiver operating characteristics curve (AuROC). Reproducibility was evaluated using correlation analysis of two HRV tests on the same patient. Results There were 37 and 33 patients in the IDH and non-IDH groups, respectively. The HRV–IDH index predicted IDH occurrence with AuROCs of 0.776 and 0.803 for patients who had experienced at least one or repeated IDH episodes, respectively. Spearman's correlation coefficient for HRV–IDH indices was 0.859 for the first and second HRV tests. Conclusions The HRV test holds promise for predicting IDH, particularly for patients with recurring IDH diagnosed based on the nadir 90 criterion.

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Clinical significance of heart rate variability for the monitoring of cardiac autonomic neuropathy in end-stage renal disease patients

Cited by 4 publications

References 45 publications

The Controversies of Coronary Artery Disease in End-Stage Kidney Disease Patients: A Narrative Review

The Controversies of Coronary Artery Disease in End-Stage Kidney Disease Patients: A Narrative Review

The Effect of Autonomic Nervous System Dysfunction on the Progression of Primary Open-Angle Glaucoma

Usefulness of the heart rate variability test in predicting intradialytic hypotension in patients undergoing chronic haemodialysis

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