Parathyroidectomy and Heart Rate Variability in Patients with Stage 5 CKD

Abstract

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.

Long–term mortality after parathyroidectomy among chronic kidney disease patients with secondary hyperparathyroidism: a systematic review and meta-analysis

“…Moreover, left ventricular function in patients with advanced sHPT and dilated cardiomyopathy was markedly improved by PTx. 40 Other possible mechanisms for post-PTx survival improvement include reduction in fracture risk; 41 improvement in anemia and hypertension, 42 cardiac autonomic nervous system, 43 life-threatening condition of calciphylaxis, 44 immune system, 45 muscle strength, 46 as well as sustained reduction in fibroblast growth factor 23.…”

Parathyroid Hormone and Heart Rate Variability in Haemodialysis Patients

“…High phosphate and PTH levels have been recently associated with decreased HRV parameters derived from 24-hour Holters in patients with end-stage CKD [13]. However, this is the first study that addresses the issue of high intra- and inter-individual variability of HRV parameters due to different external stimulations to the autonomic system.…”

“…High PTH is associated with decreased HRV indices derived from 24-hour Holter electrocardiogram (ECG) in patients with CKD stage 5 [13] and in small cohorts of dialysis patients [13,14]. However the differences in recording conditions to which the autonomic system responds makes the proof of a casual association between high PTH and reduced HRV potentially problematic.…”

Parathyroidectomy Increases Heart Rate Variability and Leptin Levels in Patients with Stage 5 Chronic Kidney Disease

“…HRV in severe SHPT was lower than in CKD patients without SHPT [4] with the underlying mechanisms remaining unclear. As an efficient therapy for severe SHPT patients, parathyroidectomy (PTX) could reverse lower HRV and reduce CVD mortality [4,20,21] , while the role of circulating leptin in this process is also obscure.…”

“…Measurement of HRV is a practical and atraumatic way to assess the cardiac automatic nervous system in the clinical settings with 24-hour Holter recordings of electrocardiogram [3] . HRV values were significantly reduced in end-stage renal disease patients [4] , which was predictive of the occurrence of CVD including cardiac arrest and arrhythmia [5] .…”