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Abstract
Low heart rate variability (HRV) has been recognized to correlate with adverse cardiovascular (CV) outcomes in hemodialysis (HD) patients. It has been reported that HRV might be improved after HD, but whether the improved HRV after HD predicts a better CV prognosis remains to be determined. This study examined the ability of the change in HRV before and after HD in predicting overall and CV mortality in HD patients. This study enrolled 182 patients under maintenance HD. HRV was examined to assess changes before and after HD. The change in HRV (ΔHRV) was defined as post-HD HRV minus pre-HD HRV. During a median follow-up period of 35.2 months, 29 deaths (15.9%) were recorded. Multivariate analysis showed that decreased ΔLF% was associated with increased overall (hazard ratios [HR], 0.978; 95% confidence interval [CI], 0.961–0.996; p = 0.019) and CV mortality (HR, 0.941; 95% CI, 0.914–0.970; p < 0.001), respectively. Moreover, adding ΔLF% to a clinical model provided an additional benefit in the prediction of overall (p = 0.002) and CV mortality (p < 0.001). HRV change before and after HD (ΔHRV) is an useful clinical marker, and it is stronger than HRV before HD in predicting overall and CV mortality.
Highlights
CV autonomic neuropathy can be evaluated by heart rate variability (HRV), a measure of variations in heart rate[5]
In patients with sur vival, very low frequency (VLF) (p < 0.001), low frequency (LF)% (p < 0.001) and LF/high frequency (HF) (p < 0.001) significantly increased after HD, and HF% (p = 0.006) decreased after HD, whereas no significant change of HRV parameters was noted in patients with mortality
We evaluated the relationship between Δ HRV parameters and overall/CV mortality in HD patients
Summary
CV autonomic neuropathy can be evaluated by heart rate variability (HRV), a measure of variations in heart rate[5]. It is defined as variations of both instantaneous heart rate and R-R intervals of electrocardiogram, and may provide a simple and noninvasive way to assess the activities of the autonomic nervous system[5]. Reduced HRV has been shown to be associated with adverse CV outcomes and mortality in HD patients[3,4], and HD itself may improve HRV6–8. The aim of this study is to assess whether the change in HRV before and after HD is associated with overall and CV mortality in HD patients
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