Non-Dipping Heart Rate, Microalbuminuria and Thrombocytosis in Type 2 Diabetes Mellitus: Can We Connect the Dots?

Kantharia, Bharat K.

doi:10.1159/000363283

Cited by 5 publications

(9 citation statements)

References 16 publications

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“…HR non‐dipping pattern have been proved to have effects on physiological and pathological processes of heart and kidney, resulting in preclinical cardiac damage, microalbuminuria, CV complications and even all‐cause or CV mortality, as previous studies reported. 8 , 14 , 17 , 29 However, studies on the association of HR dipping pattern with prognosis in CKD patients are very limited. The first study related to the HR dipping pattern in CKD patients occurred in 2019, 19 which reported the incidence of non‐dipping HR pattern was higher in hypertensive patients with CKD than that in hypertensive patients without CKD; furthermore, the risk of non‐dipping HR increased with the severity of renal insufficiency.…”

Section: Discussionmentioning

confidence: 99%

“…In the Cox regression model, the HR non-dipping pattern was not predictive of death and CV events ( Due to the circadian rhythm of the autonomic nervous system, the parasympathetic nervous system is normally dominant at night, causing HR decline. 8,25 Abnormal variation of HR rhythm has very complex pathogenesis, including abnormal circadian gene expression, 26,27 and abnormal neurohumoral system regulation, etc. 28 This will lead to the increment of sympathetic excitability, nocturnal HR elevates consequently, causing a non-dipping pattern of HR.…”

Section: Events and Deathmentioning

confidence: 99%

“…Heart rate (HR) is a clinically accessible indicator of vital signs and sympathetic activity, 4 which has been reported to be predictive of all‐cause mortality, cardiovascular disease, and renal outcome. 5 , 6 , 7 Similar to blood pressure, HR follows circadian rhythms; that is, it normally decreases by 10–20% at night due to the effect of the parasympathetic system, 8 , 9 a night HR decline less than 10% from day is defined as the HR non‐dippers. 10 …”

Section: Introductionmentioning

confidence: 99%

“…Heart rate (HR) is a clinically accessible indicator of vital signs and sympathetic activity, 4 which has been reported to be predictive of allcause mortality, cardiovascular disease, and renal outcome. [5][6][7] Similar to blood pressure, HR follows circadian rhythms; that is, it normally decreases by 10-20% at night due to the effect of the parasympathetic system, 8,9 a night HR decline less than 10% from day is defined as the HR non-dippers. 10 Circadian rhythms of heart rate can be obtained by ambulatory blood pressure monitoring(ABPM), and has been recommended to be applied in hypertensive patients by guidelines, because of the better predictability of blood pressure (BP) parameters from ABPM to prognosis compared to office/home BP.…”

Section: Introductionmentioning

confidence: 99%

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Nocturnal heart rate rising is a risk factor for poor renal outcomes in patients with chronic kidney disease and hypertension

Liu

Zhou

et al. 2022

J of Clinical Hypertension

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The association of heart rate (HR) dipping pattern with renal outcomes in chronic kidney disease (CKD) patients with hypertension has never been investigated. In order to demonstrate if HR dipping pattern is a risk factor for renal outcomes, cardiovascular (CV) diseases, and mortality in hypertensive patients with CKD, we conducted the prospective longitudinal observational study. Patients were divided into three groups according to their nocturnal HR: HR dippers (night-day HR ratio ≤ 0.9), HR non-dippers (0.9 < night-day HR ratio ≤ 1.0), and HR risers (night-day HR ratio > 1.0). The primary outcome was renal endpoint, a composite outcome of progression to end-stage renal disease (ESRD) or estimated glomerular filtration rate (eGFR) decline ≥ 50%; the secondary outcomes included poor renal outcomes, CV events, and death. A total of 34 (11.3%) patients reached renal endpoint after a follow-up of 34 ± 17 months. Both HR non-dippers and HR risers were predictive to renal endpoint (hazard ratio 2.58, 95% confidence interval (CI) 1.04-6.4, P = .04; hazard ratio 3.95, 95% CI 1.33-11.79, P = .01, respectively), while only HR risers was shown to be correlated with a decline in eGFR≥ 50% (hazard ratio 5.28, 95% CI 1.45-19.16, P < .05), and decline in eGFR (β -0.17, 95% CI -0.33--0.01, P = .04). No predictive value was found for HR dipping pattern to mortality and CV events. In conclusion, our study provided the first evidence that HR nondippers, especially risers were a risk factor for poor renal outcomes in hypertensive patients with CKD.

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Section: Discussionmentioning

confidence: 99%

Section: Events and Deathmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Nocturnal heart rate rising is a risk factor for poor renal outcomes in patients with chronic kidney disease and hypertension

Liu

Zhou

et al. 2022

J of Clinical Hypertension

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“…Blood pressure (BP) and pulse rate (PR) physiologically decrease by 10–20% at night due to the relative dominance of the parasympathetic nervous system ( 1 , 2 ). Non-dipping, the phenomenon of insufficient nocturnal BP and PR decline (defined as less than 10% from day to night), reflects autonomic imbalance.…”

Section: Introductionmentioning

confidence: 99%

Non-dipping pulse rate and chronic changes of the kidney in patients with chronic kidney disease

Oba

Kanzaki²,

Haruhara³

et al. 2023

Front. Cardiovasc. Med.

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IntroductionAn insufficient decrease in nocturnal pulse rate (PR), non-dipping PR, reflects autonomic imbalance and is associated with cardiovascular events and all-cause mortality. We aimed to investigate the clinical and microanatomical structural findings associated with the non-dipping PR status in patients with chronic kidney disease (CKD).MethodsThis cross-sectional study included 135 patients who underwent ambulatory blood pressure monitoring and kidney biopsy concurrently at our institution between 2016 and 2019. Non-dipping PR status was defined as (daytime PR-nighttime PR)/daytime PR <0.1. We compared clinical parameters and microstructural changes in the kidney between patients with and without non-dipping PR, including 24 h proteinuria, glomerular volume, and Mayo Clinic/Renal Pathology Society Chronicity Score.ResultsThe median age was 51 years (interquartile range: 35–63), 54% of which were male, and the median estimated glomerular filtration rate was 53.0 (30.0–75.0) mL/min/1.73 m2. Non-dipping PR status was observed in 39 patients. Patients with non-dipping PR were older and had worse kidney function, higher blood pressure, greater prevalence of dyslipidemia, lower hemoglobin levels, and a larger amount of urinary protein excretion than patients with dipping PR. Patients with non-dipping PR had more severe glomerulosclerosis, interstitial fibrosis, tubular atrophy, and arteriosclerosis. In the multivariable analysis, the severe chronic changes of the kidney were associated with non-dipping PR status after adjusting for age, sex, and other clinical parameters (odds ratio = 20.8; 95% confidence interval, 2.82–153; P = 0.003).ConclusionThis study is the first to indicate that non-dipping PR is significantly associated with chronic microanatomical changes in the kidneys of patients with CKD.

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Nondipping heart rate and associated factors in patients with chronic kidney disease

et al. 2019

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Non-Dipping Heart Rate, Microalbuminuria and Thrombocytosis in Type 2 Diabetes Mellitus: Can We Connect the Dots?

Cited by 5 publications

References 16 publications

Nocturnal heart rate rising is a risk factor for poor renal outcomes in patients with chronic kidney disease and hypertension

Nocturnal heart rate rising is a risk factor for poor renal outcomes in patients with chronic kidney disease and hypertension

Non-dipping pulse rate and chronic changes of the kidney in patients with chronic kidney disease

Nondipping heart rate and associated factors in patients with chronic kidney disease

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