Prognostic value of heart rate variability in patients with end-stage renal disease on chronic haemodialysis

Fukuta, Hidekatsu; Hayano, Junichiro; Ishihara, Shinji; Sakata, Sei-ichiro; Mukai, Sonoyo; Ohte, Nobuyuki; Ojika, Kazuhito; Yagi, Keiko; Matsumoto, Hiroko; Sohmiya, Sinken; Kimura, Genjiro

doi:10.1093/ndt/18.2.318

Cited by 145 publications

(140 citation statements)

References 20 publications

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“…We previously reported that reduced HRVTI and ULF were independent predictors of cardiac death in hemodialysis patients (3,4), but the number of events was insufficient as convincing evidence (24). Oikawa et al (5) conducted a 5.8-year prospective study of 383 hemodialysis patients and found that SDNN ,75 ms independently predicted all-cause and cardiovascular mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Analysis of heart rate variability (HRV) by 24-hour electrocardiography has become a noninvasive tool for risk stratification in various clinical settings, including hemodialysis patients (2)(3)(4)(5). Conventionally, two categories of measures have been used: time-domain HRV measures calculated as statistics of R-R intervals and frequency-domain HRV measures computed by spectrum analysis as R-R interval variances within specific frequency bands (6).…”

Section: Introductionmentioning

confidence: 99%

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Nonlinear Measures of Heart Rate Variability and Mortality Risk in Hemodialysis Patients

Suzuki

Aoyama

Tanaka

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Nonlinear measures of heart rate variability (HRV) have gained recent interest as powerful risk predictors in various clinical settings. This study examined whether they improve risk stratification in hemodialysis patients.Design, setting, participants, & measurements To assess heart rate turbulence, deceleration capacity, fractal scaling exponent (a 1 ), and other conventional HRV measures, 281 hemodialysis patients underwent 24-hour electrocardiography between January 2002 and May 2004 and were subsequently followed up.Results During a median 87-month follow-up, 77 patients (27%) died. Age, left ventricular ejection fraction, serum albumin, C-reactive protein, and calcium 3 phosphate independently predicted mortality. Whereas all nonlinear HRV measures predicted mortality, only decreased scaling exponent a 1 remained significant after adjusting for clinical risk factors (hazard ratio per a 0.25 decrement, 1.46; 95% confidence interval [95% CI], 1.16-1.85). The inclusion of a 1 into a prediction model composed of clinical risk factors increased the C statistic from 0.84 to 0.87 (P=0.03), with 50.8% (95% CI, 20.2-83.7) continuous net reclassification improvement for 5-year mortality. The predictive power of a 1 showed an interaction with age (P=0.02) and was particularly strong in patients aged ,70 years (n=208; hazard ratio, 1.87; 95% CI, 1.38-2.53), among whom a 1 increased the C statistic from 0.85 to 0.89 (P=0.01), with a 93.1% (95% CI, 59.3-142.0) continuous net reclassification improvement.Conclusions Scaling exponent a 1 that reflects fractal organization of short-term HRV improves risk stratification for mortality when added to the prediction model by conventional risk factors in hemodialysis patients, particularly those aged ,70 years.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nonlinear Measures of Heart Rate Variability and Mortality Risk in Hemodialysis Patients

Suzuki

Aoyama

Tanaka

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Lower HRV has a significant predictive value for various CVDs, such as ventricular arrhythmias and sudden death (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Parathyroidectomy and Heart Rate Variability in Patients with Stage 5 CKD

Zhang

Sun

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Lower heart rate variability implies increased risk of cardiovascular disease. This study aimed to evaluate the relationship between mineral metabolism and heart rate variability and longitudinal changes of heart rate variability after parathyroidectomy in stage 5 CKD patients.Design, setting, participants, & measurements This cross-sectional study included 118 stage 5 CKD patients, 87 controls, and a prospective study in two subgroups classified as successful (n=17) and unsuccessful (n=4) parathyroidectomy follow-up enrolled from March of 2011 to December of 2012. Blood examination and 24-hour Holter for heart rate variability were measured.Results Most heart rate variability indices were lower in stage 5 CKD patients. In multivariate stepwise regression models, serum intact parathyroid hormone was correlated with mean normal-to-normal R-R intervals, mean heart rate, and very low frequency, serum calcium was correlated with SD of 5-minute average of normal R-R intervals, and serum phosphorus was correlated with very low frequency and low frequency/high frequency. Compared with baseline, the successful parathyroidectomy subgroup had significant improvements in mean normal-to-normal R-R intervals, mean heart rate, SD of normal-to-normal R-R intervals, SD of 5-minute average of normal R-R intervals, very low frequency, high frequency, and low frequency/high frequency. There was no significant change of heart rate variability in patients after unsuccessful parathyroidectomy.Conclusions Disorders of mineral metabolism are associated with decreased heart rate variability in stage 5 CKD. Successful parathyroidectomy may contribute to reverse this cardiovascular disease risk in severe secondary hyperparathyroidism patients.

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“…3,12,17,18 The HRV reduction in patients with CKD is considered a risk factor for the occurrence of cardiac arrhythmias, and is associated with a higher cardiovascular mortality. 4,5 Cashion et al 19 , assessing hemodialysis patients by use of 24-hour Holter to study HRV in the time and frequency domains for a period of two years, have reported that the reduction in the SDNN, LF, and LF/HF parameters predicted cardiovascular death, especially sudden death. In that population, the reduction in HRV associated with injury to the parasympathetic system due to the structural impairment of arteries or the functional alterations of the autonomic nervous system secondary to uremic toxins.…”

Section: Discussionmentioning

confidence: 99%

“…3 In addition, the reduction in HRV represents an independent risk factor for cardiac mortality in those patients. 4,5 Thus, strategies, such as exercise training, have been implemented aiming at reducing cardiovascular mortality due to an increase in HRV and improvement of the left ventricular function, specially in the population with heart disease. 6,7 However, only a few studies have assessed the effect of an exercise training program on those cardiovascular parameters in patients with CKD undergoing hemodialysis.…”

Section: Introductionmentioning

confidence: 99%

Efeito do exercício aeróbico durante as sessões de hemodiálise na variabilidade da frequência cardíaca e na função ventricular esquerda em pacientes com doença renal crônica

Reboredo¹,

Pinheiro²,

Neder³

et al. 2010

J. Bras. Nefrol.

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Introduction: Decreased heart rate variability (HRV) in patients with end stage renal disease (ESRD) undergoing hemodialysis is predictive of cardiac death, especially due to sudden death. Objective: To evaluate the effects of aerobic training during hemodialysis on HRV and left ventricular function in ESRD patients. Methods: Twenty two patients were randomized into two groups: exercise (n = 11; 49.6 ± 10.6 years; 4 men) and control (n = 11; 43.5 ± 12.8; 4 men). Patients assigned to the exercise group were submitted to aerobic training, performed during the first two hours of hemodialysis, three times weekly, for 12 weeks. HRV and left ventricular function were assessed by 24 hours Holter monitoring and echocardiography, respectively. Results: After 12 weeks of protocol, no significant differences were observed in time and frequency domains measures of HRV in both groups. The ejection fraction improved non-significantly in exercise group (67.5 ± 12.6% vs. 70.4 ± 12%) and decreased non-significantly in control group (73.6 ± 8.4% vs. 71.4 ± 7.6%). Conclusion: A 12-week aerobic training program performed during hemodialysis did not modify HRV and did not significantly improve the left ventricular function.

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Prognostic value of heart rate variability in patients with end-stage renal disease on chronic haemodialysis

Abstract: Decreases in some HRV measures, particularly those reflecting long-term variability, are independent predictors of cardiac death in chronic haemodialysis patients.

Cited by 145 publications

References 20 publications

Nonlinear Measures of Heart Rate Variability and Mortality Risk in Hemodialysis Patients

Nonlinear Measures of Heart Rate Variability and Mortality Risk in Hemodialysis Patients

Parathyroidectomy and Heart Rate Variability in Patients with Stage 5 CKD

Efeito do exercício aeróbico durante as sessões de hemodiálise na variabilidade da frequência cardíaca e na função ventricular esquerda em pacientes com doença renal crônica

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