Abstract
BackgroundVascular access (VA) is the lifeline of hemodialysis patients. Although the autonomic nervous system might be associated with VA failure (VAF), it has never been addressed in previous studies. This study aimed to evaluate the predictive values of the heart rate variability (HRV) indices for long-term VA outcomes.MethodsThis retrospective study was conducted using a prospectively established cohort enrolling 175 adult chronic hemodialysis patients (100 women, mean age 65.1 ± 12.9 years) from June 2010 to August 2010. Each participant received a series of HRV measurements at enrollment. After a 60-month follow-up period, we retrospectively reviewed all events and therapeutic procedures of the VAs which existed at the enrollment and during the follow-up period.ResultsDuring the 60-month follow-up period, 37 (26.8%) had VAF but 138 (73.2%) didn’t. The values of most HRV indices were statistically increased during hemodialysis since initiation in the non-VAF group, but not in the VAF group. Among all participants, the independent indicators for VAF included higher normalized high-frequency (nHF) activity [hazard ratio (HR) 1.04, p = 0.005], lower low-frequency/high-frequency (LF/HF) ratio (HR 0.80, p = 0.015), experience of urokinase therapy (HR 11.18, p = 0.002), percutaneous transluminal angioplasty (HR 2.88, p = 0.003) and surgical thrombectomy (HR 2.36, p = 0.035), as well as higher baseline serum creatinine (HR 1.07, p = 0.027) and potassium level (HR 1.58, p = 0.037). In subgroup analysis, a lower sympathetic activity indicated by lower LF/HF ratio was an independent indicator for VAF (HR 0.61, p = 0.03) for tunneled cuffed catheter, but conversely played a protective role against VAF (HR 1.27, p = 0.002) for arteriovenous fistula.ConclusionsHRV is a useful tool for predicting long-term VAF among hemodialysis patients.
Highlights
IntroductionHemodialysis is the most prevalent modality of renal replacement therapy in uremic patients. [1] The vascular access (VA) is the lifeline, and a major risk factor for bloodstream infection, hospitalization, and mortality for hemodialysis patients. [1,2,3,4] VA failure (VAF) is a main cause of failure in hemodialysis. [5] In addition, the VAF is a major complication which accounts for 20% to 30% of hospitalization, [6] and a cause of the high morbidity and mortality among uremic patients receiving hemodialysis. [3, 4, 7,8,9,10] VA handling is an important clinical issue in the management of chronic hemodialysis patients.The permanent types of VAs used for hemodialysis include native arteriovenous fistula (AVF), synthetic arteriovenous graft (AVG), and tunneled cuffed catheter (TCC). [1,2,3,4] Generally speaking, the risk factors for VAF are stenosis, thrombosis, and infection. [8, 9] The critical factors contributing to the thrombosis of VA include hypotension, low intra-access pressure, and low intra-access blood flow (IABF), [5, 11] while an impaired function of autonomic nervous system (ANS) plays an important role for these situations.[12]Heart rate variability (HRV), by presenting the variation of beat-to-beat interval of heartbeat, provides a noninvasive measurement for evaluating ANS functions
A lower sympathetic activity indicated by lower LF/HF ratio was an independent indicator for vascular access (VA) failure (VAF) (HR 0.61, p = 0.03) for tunneled cuffed catheter, but played a protective role against VAF (HR 1.27, p = 0.002) for arteriovenous fistula
Heart rate variability (HRV) is a useful tool for predicting long-term VAF among hemodialysis patients
Summary
Hemodialysis is the most prevalent modality of renal replacement therapy in uremic patients. [1] The vascular access (VA) is the lifeline, and a major risk factor for bloodstream infection, hospitalization, and mortality for hemodialysis patients. [1,2,3,4] VA failure (VAF) is a main cause of failure in hemodialysis. [5] In addition, the VAF is a major complication which accounts for 20% to 30% of hospitalization, [6] and a cause of the high morbidity and mortality among uremic patients receiving hemodialysis. [3, 4, 7,8,9,10] VA handling is an important clinical issue in the management of chronic hemodialysis patients.The permanent types of VAs used for hemodialysis include native arteriovenous fistula (AVF), synthetic arteriovenous graft (AVG), and tunneled cuffed catheter (TCC). [1,2,3,4] Generally speaking, the risk factors for VAF are stenosis, thrombosis, and infection. [8, 9] The critical factors contributing to the thrombosis of VA include hypotension, low intra-access pressure, and low intra-access blood flow (IABF), [5, 11] while an impaired function of autonomic nervous system (ANS) plays an important role for these situations.[12]Heart rate variability (HRV), by presenting the variation of beat-to-beat interval of heartbeat, provides a noninvasive measurement for evaluating ANS functions. [1] The vascular access (VA) is the lifeline, and a major risk factor for bloodstream infection, hospitalization, and mortality for hemodialysis patients. [5] In addition, the VAF is a major complication which accounts for 20% to 30% of hospitalization, [6] and a cause of the high morbidity and mortality among uremic patients receiving hemodialysis. [8, 9] The critical factors contributing to the thrombosis of VA include hypotension, low intra-access pressure, and low intra-access blood flow (IABF), [5, 11] while an impaired function of autonomic nervous system (ANS) plays an important role for these situations.[12]. This study aimed to evaluate the predictive values of the heart rate variability (HRV) indices for long-term VA outcomes.
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