Abstract
Background: Atrial fibrillation (AF) is common in hemodialysis patients and contributes to increased mortality. We aimed to examine heart rate variability triangular index (HRVI) in hemodialysis patients with AF as it has recently been reported to predict mortality in AF patients without kidney disease.Methods: A total of 88 patients on hemodialysis with a medical history of AF or newly diagnosed AF underwent 24-h electrocardiography recordings. The primary endpoint of cardiovascular mortality was recorded during a median follow up of 3.0 years. Risk prediction was assessed by Cox regression, both unadjusted and adjusted for the Charlson Comorbidity Index and the Cardiovascular Mortality Risk Score.Results: Median age was 76 years, median dialysis vintage was 27 months. Altogether, 22 and 44 patients died due to cardiovascular and non-cardiovascular causes. In 55% of patients AF was present during the recording. Kaplan-Meier plots of HRVI quartiles suggested a non-linear association between HRVI, cardiovascular, and all-cause mortality which was confirmed in non-linear Cox regression analysis. Adjusted linear Cox regression revealed a hazard ratio of 6.2 (95% CI: 2.1–17.7, p = 0.001) and 2.2 (95% CI: 1.3–3.8, p = 0.002) for the outer quartiles (combined first and fourth quartile) for cardiovascular and all-cause mortality, respectively. Patients in the first quartile were more likely to have sinus rhythm whereas patients in the fourth quartile were more likely to have AF.Conclusions: We found a U-shaped association between HRVI and mortality in hemodialysis AF patients. The results might contribute to risk stratification independent of known risk scores in hemodialysis AF patients.
Highlights
End-stage kidney disease patients on hemodialysis have a markedly increased risk of cardiovascular morbidity and mortality [1]
Median heart rate variability triangular index (HRVI) was 26.3, quartiles of HRVI ranged from ≤18.245 (n = 22), 18.246–26.279 (n = 22), 26.280–34.307 (n = 22), and ≥34.08 (n = 22)
Patients in the external quartiles were not significantly different from patients in the inner quartiles, except for heart rate which was significantly higher in patients in the inner quartiles and a history of myocardial infarction which was significantly more often present in patients in the outer quartiles (Table 1)
Summary
End-stage kidney disease patients on hemodialysis have a markedly increased risk of cardiovascular morbidity and mortality [1]. The incidence and prevalence of AF are higher in hemodialysis patients than in the general population [4, 5]. This is contributed by multiple factors including age, dialysis vintage, left atrial dilatation, and high overall disease burden of hemodialysis patients [4, 6]. Among hemodialysis patients, those suffering from AF have higher morbidity and mortality [7]. We aimed to examine heart rate variability triangular index (HRVI) in hemodialysis patients with AF as it has recently been reported to predict mortality in AF patients without kidney disease
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