Synergic Impact of Vascular Calcification and Low Autonomic Tone in Mortality of Hemodialysis Patients

Ng, Hwee-Yeong; Hsueh, Shu-Kai; Lee, Yueh‐Ting; Chiou, Terry Ting-Yu; Huang, Pei-Ming; Lee, Chien-Te

doi:10.1159/000477827

Cited by 7 publications

(6 citation statements)

References 30 publications

(33 reference statements)

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“…Hemoglobin level was positively correlated with change in LF after HD in patients ≥65 years old in the present study. In line with our findings, a positive correlation between hemoglobin and LF was shown in HD patients ( Ng et al, 2017 ). This implied that better sympathetic compensation occur as a result of fluid removal during HD in patients with better hemoglobin level.…”

Section: Discussionsupporting

confidence: 92%

Association between Age and Changes in Heart Rate Variability after Hemodialysis in Patients with Diabetes

Niu

Huang

Chen

et al. 2018

Front. Aging Neurosci.

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Background: Heart rate variability (HRV) represents changes in the time between successive heart beats, and it has been used to assess the autonomic nervous system. Previous studies have reported autonomic dysfunction in diabetic patients undergoing hemodialysis (HD), however, no studies have evaluated the effects of age on changes in HRV in these patients. The aim of this study was to examine the effects of age on changes in HRV in diabetic HD patients.Methods: We enrolled 84 diabetic patients receiving maintenance HD. HRV was measured before and after HD to assess changes in HRV (ΔHRV). The patients were divided into two groups based on their age (65 years< or ≥65 years).Results: Compared to the patients aged <65 years, those aged ≥65 years had a higher high frequency (HF) % (p = 0.032) before HD. The patients aged <65 years had a significant increase in very low frequency, low frequency (LF), and HF after HD. The patients aged ≥65 years had a significant increase in LF, but a significant decrease in HF% after HD. There was a significant interaction between age and change of HF% (p = 0.023) after HD. After multivariate adjustments for clinical, biochemical data and medications, systolic blood pressure, total cholesterol, hemoglobin, and hemoglobin were associated with ΔLF, whereas cerebrovascular disease, systolic blood pressure, and fasting glucose were associated with ΔHF% in patients aged ≥65 years.Conclusion: Our study demonstrated significant changes in HRV after HD in diabetic patients. In the patients aged ≥65 years, LF was increased, whereas HF% was decreased significantly after HD. Among the HRV parameters, age had an interaction with the change of HF%.

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Section: Discussionsupporting

confidence: 92%

Association between Age and Changes in Heart Rate Variability after Hemodialysis in Patients with Diabetes

Niu

Huang

Chen

et al. 2018

Front. Aging Neurosci.

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“…VC may impact other physical pathological factors in CKD patients, bringing in high risk of cardiovascular mortality. VC was suggested to be related to autonomic dysfunction and arterial stiffness, both of which may influence the variability of blood pressure (BPV). BPV refers to the fluctuations of blood pressure (BP).…”

Section: Introductionmentioning

confidence: 99%

Vascular calcification is associated with Wnt‐signaling pathway and blood pressure variability in chronic kidney disease rats

Liao

Wang

et al. 2019

Nephrology

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Aim Vascular calcification (VC) is a common complication in chronic kidney disease (CKD) and has been shown to be associated with increased cardiovascular events and mortality. This study was to explore the role of Wnt‐signaling pathway in CKD VC, and the association between VC and blood pressure variability (BPV) which is a risk factor of cardiovascular events. Methods Adult male Sprague‐Dawley rats were divided into adenine‐induced CKD group (n = 5), 5/6 nephrectomy CKD group (n = 5), sham group (n = 5) and control group (n = 5). Low‐calcium‐high‐phosphate diets were introduced to induce vascular calcification. Both daytime (hour‐to‐hour during the day) and mid‐term (day‐to‐day for 9 days) blood pressure (BP) were collected and analyzed for BPV metrics. At sacrifice, kidney, heart and aorta samples were taken for histological analyses. Calcium deposition in aorta was identified with Alizarin Red stain and graded. Immunohistochemistry stain and western blot were performed for Wnt3a, Wnt5a, β‐catenin, sclerostin, osteopontin, and α‐SMA. Results Compared with control rats, CKD rats suffered from markedly severer VC (Grade 2.6 ± 0.2 and 1.8 ± 0.8 vs 0.0 ± 0.0 and 0.2 ± 0.4, P = .0010). VC was positively correlated with vascular Wnt3a and β‐catenin expression (P = .0032 and .0000), but not significantly associated with Wnta5a or sclerostin. Besides, CKD rats showed increased BPV (P < .001), which was also positively correlated with VC. Conclusion We confirmed that CKD rats had enhanced Wnt‐signaling in vascular tissue and severer aorta calcification together with increased BPV. Wnt pathway may be a potential target in future VC and BPV management in CKD.

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“… Zhang, et al, 2013 ). Ng et al (2017) reported that calcification of hand artery (HA) was associated with autonomic dysfunction, the patients with lower autonomic tone and severe HA calcification had the highest mortality rate. Fadaee et al (2017) found that oxidative stress is significantly and independently associated with decreased HRV in patients with CKD.…”

Section: Discussionmentioning

confidence: 99%

Nomogram Model Based on Clinical Risk Factors and Heart Rate Variability for Predicting All-Cause Mortality in Stage 5 CKD Patients

et al. 2022

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Background: Heart rate variability (HRV), reflecting circadian rhythm of heart rate, is reported to be associated with clinical outcomes in stage 5 chronic kidney disease (CKD5) patients. Whether CKD related factors combined with HRV can improve the predictive ability for their death remains uncertain. Here we evaluated the prognosis value of nomogram model based on HRV and clinical risk factors for all-cause mortality in CKD5 patients.Methods: CKD5 patients were enrolled from multicenter between 2011 and 2019 in China. HRV parameters based on 24-h Holter and clinical risk factors associated with all-cause mortality were analyzed by multivariate Cox regression. The relationships between HRV and all-cause mortality were displayed by restricted cubic spline graphs. The predictive ability of nomogram model based on clinical risk factors and HRV were evaluated for survival rate.Results: CKD5 patients included survival subgroup (n = 155) and all-cause mortality subgroup (n = 45), with the median follow-up time of 48 months. Logarithm of standard deviation of all sinus R-R intervals (lnSDNN) (4.40 ± 0.39 vs. 4.32 ± 0.42; p = 0.007) and logarithm of standard deviation of average NN intervals for each 5 min (lnSDANN) (4.27 ± 0.41 vs. 4.17 ± 0.41; p = 0.008) were significantly higher in survival subgroup than all-cause mortality subgroup. On the basis of multivariate Cox regression analysis, the lnSDNN (HR = 0.35, 95%CI: 0.17–0.73, p = 0.01) and lnSDANN (HR = 0.36, 95% CI: 0.17–0.77, p = 0.01) were associated with all-cause mortality, their relationships were negative linear. Spearman’s correlation analysis showed that lnSDNN and lnSDANN were highly correlated, so we chose lnSDNN, sex, age, BMI, diabetic mellitus (DM), β-receptor blocker, blood glucose, phosphorus and ln intact parathyroid hormone (iPTH) levels to build the nomogram model. The area under the curve (AUC) values based on lnSDNN nomogram model for predicting 3-year and 5-year survival rates were 79.44% and 81.27%, respectively.Conclusion: In CKD5 patients decreased SDNN and SDANN measured by HRV were related with their all-cause mortality, meanwhile, SDNN and SDANN were highly correlated. Nomogram model integrated SDNN and clinical risk factors are promising for evaluating their prognosis.

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Synergic Impact of Vascular Calcification and Low Autonomic Tone in Mortality of Hemodialysis Patients

Cited by 7 publications

References 30 publications

Association between Age and Changes in Heart Rate Variability after Hemodialysis in Patients with Diabetes

Association between Age and Changes in Heart Rate Variability after Hemodialysis in Patients with Diabetes

Vascular calcification is associated with Wnt‐signaling pathway and blood pressure variability in chronic kidney disease rats

Nomogram Model Based on Clinical Risk Factors and Heart Rate Variability for Predicting All-Cause Mortality in Stage 5 CKD Patients

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