PROGNOSIS OF LIFE IMPROVEMENT AFTER LIVING-RELATED RENAL TRANSPLANTATION BY ANALYSIS OF HEART RATE VARIABILITY IN LONG-TERM ELECTROCARDIOGRAM

Abstract

P324 Aims: Despite recent advances in hemodialysis techniques and medical management for end-stage renal disease (ESRD), mortality is still high among chronic hemodialysis patients. In such patients, cardiovascular complications are leading cause of death. Analysis of heart rate dynamics (R-R intervals) using a long-term electrocardiogram provides prognostic information for patients under various clinical situations. Decreased heart rate variability (HRV) predicts the risk for cardiac death in patients with ESRD. There is no data on prognosis of life after renal transplantation compared to before, using 24 hours HRV analysis. The purpose of this study is to determine therapeutic value of renal transplantation on prognosis of life, by HRV using 24 hours electrocardiogram in a prospective analysis in ESRD patients. Methods: Between March 2002 and May 2003, out of 36 patients before living-related renal transplantation in our department, 24 were enrolled in this study. We excluded 12 patients because of diabetes mellitus, s-Cre>2mg/dl at 6 months, treatment with βblocker before or after transplantation. 24 patients (15 male, 9 female) were aged 37±11 years. Before transplantation, they had been on hemodialysis for 5.3±6.8 years. 4 patients were preemptive. 24 hours electrocardiogram was performed at before operation which is in a dialysis-free day of the middle week, 1month, 6months, 12months after operation. All recordings were made in hospitalization. We used Nihon Kouden RAS3102 as a 24 hours electrocardiogram, and after distinguishing QRS complex, we analyzed it by using MemCalc®. Results: Standard deviation of all R-R intervals during 24 hours (SDNN) which is a predictor of disease prognosis was improved from 115.5±33.1 ms to 151.3±34.3 ms (p=0.0004) significantly in 6 months after transplantaion, and HRV triangular index (total number of all R-R intervals divided by the height of the histogram of R-R intervals measured on a discrele scale with bins of 7.8125 ms) as a predictor of disease prognosis was significantly improved from 33.4±11.4 to 42.7±10.3 (p=0.0013) in 6 months after transplantaion. Power of high frequency band (HF) as a predictor of parasympathetic function and power of low frequency band (LF)/HF as a predictor of sympathetic function had a tendency to improve from 128.7±115.4 ms2 to 232.7±270.2 ms2 (p=0.07), from 8.0±9.9 to 4.6±2.8 (p=0.07) respectively in 6 months after transplantaion, but not significant. Power of ultra low frequency (ULF) and power of very low frequency (VLF), which are predictors of disease prognosis, were improved from 3065±1370 ms2 to 4861±2033 ms2 (p=0.0008), 1439±825 ms2 to 2150±836 ms2 (p=0.0013) respectively in 6 months after transplantaion. All predictors but SDNN and ULF were not significantly improved in a month after transplantation. Conclusions: Prognosis of life under chronic hemodialysis is dramatically improved from just 6 months after renal transplantation. This improvement is earlier than recovery of autonomic function.