Abstract
Low heart rate variability (HRV) is independently associated with increased risk of sudden cardiac death (SCD) and all cardiac death in haemodialysis patients. Long chain n-3 polyunsaturated fatty acids (LC n-3 PUFA) may exert anti-arrhythmic effects. This study aimed to investigate relationships between dialysis, sleep and 24 h HRV and LC n-3 PUFA status in patients who have recently commenced haemodialysis. A cross-sectional study was conducted in adults aged 40–80 with chronic kidney disease (CKD) stage 5 (n = 45, mean age 58, SD 9, 20 females and 25 males, 39% with type 2 diabetes). Pre-dialysis blood samples were taken to measure erythrocyte and plasma fatty acid composition (wt % fatty acids). Mean erythrocyte omega-3 index was not associated with HRV following adjustment for age, BMI and use of β-blocker medication. Higher ratios of erythrocyte eicosapentaenoic acid (EPA) to docosahexaenoic acid (DHA) were associated with lower 24 h vagally-mediated beat-to-beat HRV parameters. Higher plasma EPA and docosapentaenoic acid (DPAn-3) were also associated with lower sleep-time and 24 h beat-to-beat variability. In contrast, higher plasma EPA was significantly related to higher overall and longer phase components of 24 h HRV. Further investigation is required to investigate whether patients commencing haemodialysis may have compromised conversion of EPA to DHA, which may impair vagally-mediated regulation of cardiac autonomic function, increasing risk of SCD.
Highlights
Cardiovascular disease is prevalent in chronic kidney disease (CKD) [1], and accounts for 43% of all-cause mortality among dialysis patients [2], compared to an estimated 11% of deaths in the general population [3]
Demographic and clinical characteristics for the total population enrolled in the study is presented in Table 1, including 2 h heart rate variability (HRV) parameters during dialysis
Of the 45 patients, patients provided HRV recordings of sufficient quality to be included in the 2 h dialysis period, provided sleeptime HRV recordings of sufficient quality, and 35 provided 24 h recordings of sufficient quality for analysis
Summary
Cardiovascular disease is prevalent in chronic kidney disease (CKD) [1], and accounts for 43% of all-cause mortality among dialysis patients [2], compared to an estimated 11% of deaths in the general population [3]. Risk of sudden cardiac death (SCD) is doubled when a patient with CKD stage 5 (kidney failure) starts dialysis [4]. In patients on haemodialysis, SCD accounts for two thirds of all cardiac deaths and one fourth of all-cause mortality [2]. Patients with kidney failure are a population with low heart rate variability (HRV) indicating autonomic dysfunction [5]. Low HRV has been independently associated with increased risk of all-cause mortality, SCD and all cardiac death in haemodialysis patients [6,7,8]. Supplementation with LC n-3 PUFA is a promising candidate for SCD prevention in this population due to their potential antiinflammatory, anti-oxidative and anti-arrhythmic effects on the cardiac myocytes [13,14,15]
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