Heart rate variability according to electrolyte changes during hemodialysis in patients with chronic kidney disease

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Autonomic neuropathy commonly arises as a long-term complication in chronic kidney disease (CKD) and can be diagnosed from heart rate variability (HRV), calculated from electrocardiogram (ECG) recordings. Purpose There is limited data about HRV using real-time ECG according to electrolyte levels during hemodialysis (HD) in patients with CKD. Methods Total of 50 patients (62.1±10.7 years) with CKD underwent continuous real-time ECG monitor (237.4±15.3 mins) during HD for HRV using remote monitoring system and checked electrolyte levels before/after HD. And we compared HRV according to electrolyte levels. Results During the monitor, we checked total 2374 times of ECG and electrolyte level simultaneously of all patients. Both time and frequency domain HRV were higher when the patients had lower K+ level change before/after HD (<0.5mEq/L) as compared with those with higher K+ level change (>0.5mEq/L) in Table. In addition, there were higher incidence of arrhythmic events including atrial/ventricular premature complexes, even though no difference of mean heart rate in patients with lower K+ level change group (P<0.001). Conclusions Poor controlled K+ level during hemodialysis was independently associated with higher HRV in patients with CKD. This is further substantiated by independent continuous associations between real-time measures of K+ level and higher HRV. These data strongly suggest that cardiac autonomic dysfunction can be caused by lower change before/after hemodialysis alone.