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

Bıyık, Zeynep; Yavuz, Yasemin; Altıntepe, Lütfullah; Çelik, Gülperi; Güney, İ̇brahim; Oktar, Sevil Fisekci

doi:10.1007/s10157-019-01782-x

Cited by 9 publications

(9 citation statements)

References 32 publications

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“…Non-dipping hypertension with disrupted circadian rhythm and low heart rate was seen in the CKD model mice, confirming the circadian disruption in this model and similarity with human CKD patients. 24 Finally, Clock mutant mice with a dysfunctional circadian timing system proved to be more sensitive to adenine-induced kidney damage than were WT controls, which is caused by higher adenine metabolite deposition and higher MMP expressions in the kidney.…”

Section: Discussionmentioning

confidence: 99%

The circadian clock is disrupted in mice with adenine-induced tubulointerstitial nephropathy

Motohashi

Tahara

Whittaker

et al. 2020

Kidney International

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Sleep disorders are prevalent in chronic kidney disease patients, although the underlying mechanisms are not understood. The current study demonstrates that adenine-induced tubulointerstitial nephropathy disrupted the circadian system both centrally and in peripheral organs. Clock mutant mice were also more vulnerable to the effects of adenine. These findings aid the understanding of sleep disturbances in adenine phosphoribosyltransferase deficiency, a rare inherited metabolic disorder that leads to the accumulation of 2,8dihydroxyadenine. More broadly, the results suggest that circadian disruption caused by environmental factors such as nighttime shift work may be a risk factor for chronic kidney disease development.

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Section: Discussionmentioning

confidence: 99%

The circadian clock is disrupted in mice with adenine-induced tubulointerstitial nephropathy

Motohashi

Tahara

Whittaker

et al. 2020

Kidney International

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“… 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. 19 As our study illustrated, HR non‐dipping pattern accelerated the CKD progression and resulted in a poor renal prognosis, so it is essentially a vicious circle and alerts us of the importance and necessity of paying attention to monitoring circadian rhythms of HR in hypertensive patients with CKD.…”

Section: Discussionmentioning

confidence: 99%

“…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. 19 As our study illustrated, HR non‐dipping pattern accelerated the CKD progression and resulted in a poor renal prognosis, so it is essentially a vicious circle and alerts us of the importance and necessity of paying attention to monitoring circadian rhythms of HR in hypertensive patients with CKD. Despite pieces of evidences on the clinical usefulness of nocturnal HR monitor in predicting renal function impairment and cardiac damage, the current guidelines do not consider the HR monitor in the therapeutic management of CKD, 30 , 31 circadian rhythm of HR deserves further attention in CKD patients.…”

Section: Discussionmentioning

confidence: 99%

“…6,[15][16][17][18] However, to the best of our knowledge, studies on the association of HR dipping pattern with prognosis in CKD patients are very limited. The first study related to HR dipping pattern in CKD patients occurred in 2019, which reported the high prevalence (43.3% in the hypertensive pre-dialysis patients and 77.4% in the hypertensive hemodialysis patients) of nondipping HR in CKD patients 19 ; subsequently, a study conducted by Cui and associates in 2021 demonstrated that non-dipping HR was a prognostic marker of all-cause mortality in CKD patients with stage 5. 20 To further investigate the association of HR dipping pattern with renal and heart outcomes in patients with CKD and hypertension, we conducted this prospective longitudinal observational study.…”

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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“…However, little is known about non-dipping PR in patients with CKD. A recent cross-sectional study showed that the prevalence of non-dipping PR was higher in CKD and hemodialysis patients than in the general population ( 14 , 17 ). Previous clinical and experimental studies have suggested that autonomic cardiovascular alterations occur in the presence of CKD, contributing to cardiovascular morbidity and mortality ( 18 , 19 ).…”

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

Cited by 9 publications

References 32 publications

The circadian clock is disrupted in mice with adenine-induced tubulointerstitial nephropathy

The circadian clock is disrupted in mice with adenine-induced tubulointerstitial nephropathy

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

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