Heart rate variability in advanced chronic kidney disease with or without diabetes: midterm effects of the initiation of chronic haemodialysis therapy

Mylonopoulou, M.; Tentolouris, Nicholas; Antonopoulos, Stavros; Mikros, Sotirios; Katsaros, Konstantinos; Μelidonis, Αndreas; Sevastos, Nikolaos; Katsilambros, Nikolaos

doi:10.1093/ndt/gfq226

Cited by 39 publications

(65 citation statements)

References 36 publications

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“…Post-dialysis systolic blood pressure was lower in the intensive vitamin D group ( p = 0.03), but blood pressure was well controlled in both groups. All measures of HRV were depressed but were similar between groups and comparable to published measures in the ESKD population [3,24,28,30]. …”

Section: Resultssupporting

confidence: 80%

“…Age, sex treatment sequence, prior vitamin D supplementation, baseline calcium, parathyroid hormone, dialysis adequacy (kt/V), and β-blocker medication were tested as potential effect modifiers within the model, recognizing that the ability to detect significance was limited by sample size. Subgroup analyses were conducted for subjects with diabetes mellitus [28] and subjects on nocturnal hemodialysis [29]. Missing HRV values were imputed utilizing an expectation–maximization (EM) technique.…”

Section: Methodsmentioning

confidence: 99%

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The VITAH Trial—Vitamin D Supplementation and Cardiac Autonomic Tone in Patients with End-Stage Kidney Disease on Hemodialysis: A Blinded, Randomized Controlled Trial

et al. 2016

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End-stage kidney disease (ESKD) patients are at increased cardiovascular risk. Vitamin D deficiency is associated with depressed heart rate variability (HRV), a risk factor depicting poor cardiac autonomic tone and risk of cardiovascular death. Vitamin D deficiency and depressed HRV are highly prevalent in the ESKD population. We aimed to determine the effects of oral vitamin D supplementation on HRV ((low frequency (LF) to high frequency (HF) spectral ratio (LF:HF)) in ESKD patients on hemodialysis. Fifty-six subjects with ESKD requiring hemodialysis were recruited from January 2013–March 2015 and randomized 1:1 to either conventional (0.25 mcg alfacalcidol plus placebo 3×/week) or intensive (0.25 mcg alfacalcidol 3×/week plus 50,000 international units (IU) ergocalciferol 1×/week) vitamin D for six weeks. The primary outcome was the change in LF:HF. There was no difference in LF:HF from baseline to six weeks for either vitamin D treatment (conventional: p = 0.9 vs. baseline; intensive: p = 0.07 vs. baseline). However, participants who remained vitamin D-deficient (25-hydroxyvitamin D < 20 ng/mL) after treatment demonstrated an increase in LF:HF (conventional: n = 13, ∆LF:HF: 0.20 ± 0.06, p < 0.001 vs. insufficient and sufficient vitamin D groups; intensive: n = 8: ∆LF:HF: 0.15 ± 0.06, p < 0.001 vs. sufficient vitamin D group). Overall, six weeks of conventional or intensive vitamin D only augmented LF:HF in ESKD subjects who remained vitamin D-deficient after treatment. Our findings potentially suggest that while activated vitamin D, with or without additional nutritional vitamin D, does not appear to improve cardiac autonomic tone in hemodialysis patients with insufficient or sufficient baseline vitamin D levels, supplementation in patients with severe vitamin D deficiency may improve cardiac autonomic tone in this higher risk sub-population of ESKD. Trial Registration: ClinicalTrials.gov, NCT01774812.

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Section: Resultssupporting

confidence: 80%

Section: Methodsmentioning

confidence: 99%

The VITAH Trial—Vitamin D Supplementation and Cardiac Autonomic Tone in Patients with End-Stage Kidney Disease on Hemodialysis: A Blinded, Randomized Controlled Trial

et al. 2016

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“…In nondiabetic, but not diabetic, ESRD patients receiving chronic hemodialysis therapy, Giordano et al [218] reported a marked improvement in HRV, which correlated negatively with uremia. Mylonopoulou et al [219], in contrast, observed enhanced HRV parameters in both diabetic and nondiabetic ESRD patients, but the effect was more pronounced in the nondiabetic population. Conversion from conventional to nocturnal hemodialysis, which allows more efficient removal of uremic toxins, was associated with improved BRS, increased HF (vagal) power of HRV, and a normalized LF/HF ratio of HRV [101,220].…”

Section: Renal Replacement Therapymentioning

confidence: 85%

Cardiovascular Autonomic Dysfunction in Chronic Kidney Disease: a Comprehensive Review

Salman

2015

Curr Hypertens Rep

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Cardiovascular autonomic dysfunction is a major complication of chronic kidney disease (CKD), likely contributing to the high incidence of cardiovascular mortality in this patient population. In addition to adrenergic overdrive in affected individuals, clinical and experimental evidence now strongly indicates the presence of impaired reflex control of both sympathetic and parasympathetic outflow to the heart and vasculature. Although the principal underlying mechanisms are not completely understood, potential involvements of altered baroreceptor, cardiopulmonary, and chemoreceptor reflex function, along with factors including but not limited to increased renin-angiotensin-aldosterone system activity, activation of the renal afferents and cardiovascular structural remodeling have been suggested. This review therefore analyzes potential mechanisms underpinning autonomic imbalance in CKD, covers results accumulated thus far on cardiovascular autonomic function studies in clinical and experimental renal failure, discusses the role of current interventional and therapeutic strategies in ameliorating autonomic deficits associated with chronic renal dysfunction, and identifies gaps in our knowledge of neural mechanisms driving cardiovascular disease in CKD.

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“…One of the serious consequences of CKD in the cardiovascular system is impairment in the autonomic cardiovascular control, which is reflected in the depressed HRV. Although, hemodialysis procedure ameliorate clinical outcomes and survival in uremic patients, chronic exposure to hemodialysis seems to induce changes in HRV [94]. In addition autonomic neuropathy induce alterations in HRV and there is evidence that high fluid overload met in hemodialysis patients also impairs ANS activity, leads to hypertension and left ventricular hyperthrophy where enhances cardiac mortality [95].…”

Section: Discussion-conclusionmentioning

confidence: 99%

Intra-Renal Hemodynamic Changes After Habitual Physical Activity in Patients with Chronic Kidney Disease

Καλτσάτου¹,

Karatzaferi²,

Mitrou³

et al. 2016

CPD

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Heart rate variability in advanced chronic kidney disease with or without diabetes: midterm effects of the initiation of chronic haemodialysis therapy

Cited by 39 publications

References 36 publications

The VITAH Trial—Vitamin D Supplementation and Cardiac Autonomic Tone in Patients with End-Stage Kidney Disease on Hemodialysis: A Blinded, Randomized Controlled Trial

The VITAH Trial—Vitamin D Supplementation and Cardiac Autonomic Tone in Patients with End-Stage Kidney Disease on Hemodialysis: A Blinded, Randomized Controlled Trial

Cardiovascular Autonomic Dysfunction in Chronic Kidney Disease: a Comprehensive Review

Intra-Renal Hemodynamic Changes After Habitual Physical Activity in Patients with Chronic Kidney Disease

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