Heart Rate Variability Change Before and After Hemodialysis is Associated with Overall and Cardiovascular Mortality in Hemodialysis

Chen, Szu-Chia; Huang, Jiun-Chi; Tsai, Yi‐Chun; Hsiu-Chin, R. N.; Chen, R. N. Jui-Hsin; Kuo, Po‐Lin; Chang, Jer‐Ming; Hwang, Shiuh-Lin; Chen, Hung‐Chun

doi:10.1038/srep20597

Cited by 32 publications

(53 citation statements)

References 28 publications

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“…CRF patients with overall reduced HRV (e.g., decreased SDNN) or altered behavior in HRV dynamics (e.g., decreased α 1 ) have a higher mortality risk . Moreover, a large reduction of the spectral power within LF after HD also predicts both overall and cardiovascular mortality . One of the main findings of this study is that CRF patients with stable blood pressure response during HD show dynamical changes introduced by an orthostatic challenge (active standing) of the short‐term scaling exponent ( α 1 ) that are similar (i.e., in the same direction) to those exhibited by healthy age‐matched subjects.…”

Section: Discussionmentioning

confidence: 66%

Effects of Orthostatism and Hemodialysis on Mean Heart Period and Fractal Heart Rate Properties of Chronic Renal Failure Patients

Infante¹,

Pérez-Grovas²,

González

et al. 2017

Artificial Organs

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The aim of this work was to evaluate the short-term fractal index (α ) of heart rate variability (HRV) in chronic renal failure (CRF) patients by identifying the effects of orthostatism and hemodialysis (HD), and by evaluating the correlation between α and the mean RR interval from sinus beats (meanNN). HRV time series were derived from ECG data of 19 CRF patients and 20 age-matched healthy subjects obtained at supine and orthostatic positions (lasting 5 min each). Data from CRF patients were collected before and after HD. α was calculated from each time series and compared by analysis of variance. Pearson's correlations between meanNN and α were calculated using the data from both positions by considering three groups: healthy subjects, CRF before HD and CRF after HD. At supine position, α of CRF patients after HD (1.17 ± 0.30) was larger (P < 0.05) than in healthy subjects (0.89 ± 0.28) but not before HD (1.10 ± 0.34). α increased (P < 0.05) in response to orthostatism in healthy subjects (1.29 ± 0.26) and CRF patients after HD (1.34 ± 0.31), but not before HD (1.25 ± 0.37). Whereas α was correlated (P < 0.05) with the meanNN of healthy subjects (r = -0.562) and CRF patients after HD (r = -0.388), no significance in CRF patients before HD was identified (r = 0.003). Multiple regression analysis confirmed that α was mainly predicted by the orthostatic position (in all groups) and meanNN (healthy subjects and patients after HD), showing no association with the renal disease condition in itself. In conclusion, as in healthy subjects, α of CRF patients correlates with meanNN after HD (indicating a more irregular-like HRV behavior at slower heart rates). This suggests that CRF patients with stable blood pressure preserve a regulatory adaptability despite a shifted setting point of the heart period (i.e., higher heart rate) in comparison with healthy subjects.

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Section: Discussionmentioning

confidence: 66%

Effects of Orthostatism and Hemodialysis on Mean Heart Period and Fractal Heart Rate Properties of Chronic Renal Failure Patients

Infante¹,

Pérez-Grovas²,

González

et al. 2017

Artificial Organs

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“…Chen et al identified that ΔHRV, defined as post-minus pre-HD HRV, was a risk factor for overall and CV mortality in patients with HD. Furthermore, they found that adding ΔHRV to a model consisting of various clinical parameters improved the prediction of poor outcomes [78]. Therefore, dynamic changes in HRV before and after HD may more accurately reflect impaired CV autonomic neuropathy than resting HRV prior to HD.…”

Section: Lead Ecg P Wavementioning

confidence: 99%

Prognostic Cardiovascular Markers in Chronic Kidney Disease

Chen

Huang

et al. 2018

Kidney Blood Press Res

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Chronic kidney disease (CKD), including end-stage renal disease (ESRD), is a public health issue worldwide, and is associated with high rates of morbidity and mortality. In addition, cardiovascular disease is a major cause of mortality in these patients. Both traditional and nontraditional risk factors associated with CKD can lead to remodeling of the myocardium and blood vessels, thereby resulting in cardiomyopathy, atherosclerosis and arterial stiffness. This can subsequently lead to ischemic heart disease, heart failure, cardiovascular death, rapid renal progression and progression to ESRD. Identifying these risk factors to allow for aggressive preventive and interventional strategies is important for the management of patients with CKD. This aim of this review was to survey the clinical outcomes of CKD using cardiac and vascular markers including echocardiographic parameters, systolic time intervals, electrocardiography, heart rate variability, ankle-brachial index, pulse wave velocity, differences between interarm and interankle blood pressure, and vascular calcification.

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“…The detailed measurements and procedures for HRV analysis were previously reported (12,(16)(17)(18). All measurements for the spectral analysis were conducted in a quiet HD room.…”

Section: Hrv Analysis For Csrmentioning

confidence: 99%

“…Meanwhile, diabetic autonomic neuropathy (DAN), a serious complication of diabetes mellitus (DM), plays a pivotal role in the pathogenesis of cardiac autonomic neuropathy (CAN) (10). Since end-stage renal disease (ESRD) is most often caused by DM, the heart rate variability (HRV) used for quantification of CAN serves as a valuable non-invasive monitoring tool for patient safety (11,12).…”

Section: Introductionmentioning

confidence: 99%

A Joint Evaluation of Impaired Cardiac Sympathetic Responses and Malnutrition-Inflammation Cachexia for Mortality Risks in Hemodialysis Patients

Chang

Hsieh

et al. 2020

Front. Med.

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Background: Cardiac sympathetic response (CSR) and malnutrition-inflammation syndrome (MIS) score are validated assessment tools for patients' health condition. We aim to evaluate the joint effect of CSR and MIS on all-cause and cardiovascular (CV) mortality in patients with hemodialysis (HD). Methods: Changes in normalized low frequency (nLF) during HD were utilized for quantification of CSR. Unadjusted and adjusted hazard ratios (aHRs) of mortality risks were analyzed in different groups of nLF and MIS score. Results: In multivariate analysis, higher nLF was related to all-cause, CV and sudden cardiac deaths [aHR: 0.78 (95% confidence interval (CI): 0.72-0.85), 0.78 (95% CI: 0.70-0.87), and 0.74 (95% CI: 0.63-0.87), respectively]. Higher MIS score was associated with incremental risks of all-cause, CV and sudden cardiac deaths [aHR: 1.36 (95% CI: 1.13-1.63), 1.33 (95% CI: 1.06-1.38), and 1.50 (95% CI: 1.07-2.11), respectively]. Patients with combined lower nLF (≤6.8 nu) and higher MIS score were at the greatest risk of all-cause and CV mortality [aHR: 5.64 (95% CI: 1.14-18.09) and 5.86 (95% CI: 1.64-13.65), respectively]. Conclusion: Our data indicate a joint evaluation of CSR and MIS score to identify patients at high risk of death is more comprehensive and convincing. Considering the extremely high prevalence of cardiac autonomic neuropathy and malnutrition-inflammation cachexia in HD population, a non-invasive monitoring system composed of CSR analyzer and MIS score calculator should be developed in the artificial intelligence-based prediction of clinical events.

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Heart Rate Variability Change Before and After Hemodialysis is Associated with Overall and Cardiovascular Mortality in Hemodialysis

Cited by 32 publications

References 28 publications

Effects of Orthostatism and Hemodialysis on Mean Heart Period and Fractal Heart Rate Properties of Chronic Renal Failure Patients

Effects of Orthostatism and Hemodialysis on Mean Heart Period and Fractal Heart Rate Properties of Chronic Renal Failure Patients

Prognostic Cardiovascular Markers in Chronic Kidney Disease

A Joint Evaluation of Impaired Cardiac Sympathetic Responses and Malnutrition-Inflammation Cachexia for Mortality Risks in Hemodialysis Patients

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