Nonlinear Measures of Heart Rate Variability and Mortality Risk in Hemodialysis Patients

Context Cardiac autonomic function has been associated with mortality in patients with end-stage renal disease. It is unknown whether end-stage renal disease patients who have succumbed to sudden cardiac death can be better identified by a newer test of heart rate variability that uses spectral analysis, rather than laboratory evoked measures. Objective This series of studies sought to characterize cardiac autonomic function in patients awaiting kidney transplantation, identify factors associated with heart rate variability, identify tests which distinguish patients at-risk for death, and compare evoked measures with 24-hour heart rate variability measures. Patients Data were collected on 184 nondiabetics, 60 type 1 diabetics, and 34 type 2 diabetics with end-stage renal disease, all of whom had been referred for kidney transplantation. Main Outcome Measures The 278 patients and 67 healthy control subjects underwent evoked tests (changes in heart rate with deep breathing and Valsalva maneuver) and 24-hour heart rate variability Holter monitoring (time and frequency domains). Five patients had sudden cardiac deaths during the study. Results Data showed that end-stage renal disease patients, particularly diabetics, had compromised autonomic function. The standard deviation of all R-to-R intervals for the electrocardiogram recording (<50 minutes in 60% of the deceased patients), a 24-hour heart rate variability time domain measure, holds the promise of identifying patients at increased risk for death. Exercise was identified as a factor associated with better autonomic function. Examining relationships between 24-hour heart rate variability and characteristics of patients who succumb to death could make quantification of the mortality risk for individual pretransplant end-stage renal disease patients possible, much as it has in other populations. The data from this study may also make it possible to design interventions, such as exercise, aimed at reducing mortality risk.

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Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham Heart Study.

Circulation ◽

10.1161/01.cir.90.2.878 ◽

1994 ◽

Vol 90 (2) ◽

pp. 878-883 ◽

Cited By ~ 632

Author(s):

H Tsuji ◽

F J Venditti ◽

E S Manders ◽

J C Evans ◽

M G Larson ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Mortality Risk ◽

Framingham Heart Study ◽

Heart Study ◽

Elderly Cohort

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Effects of Dialysate Glucose Concentration on Heart Rate Variability in Chronic Hemodialysis Patients: Results of a Prospective Randomized Trial

Kidney & Blood Pressure Research ◽

10.1159/000327851 ◽

2011 ◽

Vol 34 (5) ◽

pp. 334-343 ◽

Cited By ~ 7

Author(s):

Manuela Ferrario ◽

Jochen G. Raimann ◽

Stephan Thijssen ◽

Maria Gabriella Signorini ◽

Anja Kruse ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Randomized Trial ◽

Glucose Concentration ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Prospective Randomized Trial

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MP599PROGNOSTIC VALUE OF THE 5-MINUTE HEART RATE VARIABILITY DURING ORTHOSTASIS IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfx177.mp599 ◽

2017 ◽

Vol 32 (suppl_3) ◽

pp. iii651-iii652

Author(s):

Olga Bilevich ◽

Nikolay Ovsyannikov ◽

Vyacheslav Tereshchenko

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Hemodialysis Patients

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Influence of Ischemia on Heart-Rate Variability in Chronic Hemodialysis Patients

Renal Failure ◽

10.1081/jdi-200042858 ◽

2005 ◽

Vol 27 (1) ◽

pp. 7-12 ◽

Cited By ~ 7

Author(s):

Isaline Coquet ◽

Christiane Mousson ◽

Gerard Rifle ◽

Gabriel Laurent ◽

Daniel Moreau ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Hemodialysis Patients ◽

Chronic Hemodialysis

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Association of Low Heart Rate Variability with Atherosclerotic Cardiovascular Disease in Hemodialysis Patients

Medical Principles and Practice ◽

10.1159/000189804 ◽

2009 ◽

Vol 18 (2) ◽

pp. 85-92 ◽

Cited By ~ 9

Author(s):

J.C. Longenecker ◽

M. Zubaid ◽

K.V. Johny ◽

A.I. Attia ◽

J. Ali ◽

...

Keyword(s):

Cardiovascular Disease ◽

Heart Rate ◽

Heart Rate Variability ◽

Hemodialysis Patients ◽

Atherosclerotic Cardiovascular Disease

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Heart Rate Variability during Chronic Hemodialysis and after Renal Transplantation

Journal of the American Society of Nephrology ◽

10.1681/asn.v1091972 ◽

1999 ◽

Vol 10 (9) ◽

pp. 1972-1981

Author(s):

DVORA RUBINGER ◽

DAN SAPOZNIKOV ◽

ARTHUR POLLAK ◽

MORDECAI M. POPOVTZER ◽

MYRON H. LURIA

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Renal Transplantation ◽

Heart Diseases ◽

Low Frequency ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Systemic Amyloidosis ◽

Humoral Factors ◽

Uremic Patients

Abstract. The present study was undertaken to compare heart rate variability (HRV) values in patients on maintenance hemodialysis with no evidence of ischemic or hypertensive heart diseases to those of age- and gender-matched healthy individuals and those of patients after renal transplantation. To assess the effects of a common confounding factor, HRV values were also determined in patients with systemic amyloidosis, in chronic hemodialysis, and after successful renal transplantation. Spectral analyses of RR intervals from continuous electrocardiogram recordings were performed to quantify ultra low frequency, very low frequency, low frequency, and high frequency powers. HRV determinations were all significantly reduced in uremic patients undergoing hemodialysis compared with the healthy control subjects, especially in those with systemic amyloidosis. Renal transplantation normalized HRV in most patients; HRV, however, remained reduced in isolated amyloidosis patients with cardiac or adrenal involvement. HRV circadian day/night differences were preserved in hemodialysis patients and after renal transplantation in those without amyloidosis but not in those with amyloidosis. These data suggest that reduced HRV in chronic hemodialysis patients may precede other manifestations of cardiovascular disease. In uremic patients with amyloidosis, a more severe form of autonomic failure may occur. Successful transplantation corrects HRV abnormalities in most patients, suggesting that the autonomic dysfunction of uremia is caused by humoral factors reversed by the normalization of the renal function.

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Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16101725 ◽

2019 ◽

Vol 16 (10) ◽

pp. 1725 ◽

Cited By ~ 4

Author(s):

Jeremy Zhenwen Pong ◽

Stephanie Fook-Chong ◽

Zhi Xiong Koh ◽

Mas’uud Ibnu Samsudin ◽

Takashi Tagami ◽

...

Keyword(s):

Emergency Department ◽

Heart Rate ◽

Heart Rate Variability ◽

Risk Stratification ◽

Mortality Risk ◽

Early Warning ◽

Apache Ii ◽

Early Warning Score ◽

Disease Severity Score ◽

Combination Model

The emergency department (ED) serves as the first point of hospital contact for many septic patients, where risk-stratification would be invaluable. We devised a combination model incorporating demographic, clinical, and heart rate variability (HRV) parameters, alongside individual variables of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Mortality in Emergency Department Sepsis (MEDS) scores for mortality risk-stratification. ED patients fulfilling systemic inflammatory response syndrome criteria were recruited. National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), quick SOFA (qSOFA), SOFA, APACHE II, and MEDS scores were calculated. For the prediction of 30-day in-hospital mortality, combination model performed with an area under the receiver operating characteristic curve of 0.91 (95% confidence interval (CI): 0.88–0.95), outperforming NEWS (0.70, 95% CI: 0.63–0.77), MEWS (0.61, 95% CI 0.53–0.69), qSOFA (0.70, 95% CI 0.63–0.77), SOFA (0.74, 95% CI: 0.67–0.80), APACHE II (0.76, 95% CI: 0.69–0.82), and MEDS scores (0.86, 95% CI: 0.81–0.90). The combination model had an optimal sensitivity and specificity of 91.4% (95% CI: 81.6–96.5%) and 77.9% (95% CI: 72.6–82.4%), respectively. A combination model incorporating clinical, HRV, and disease severity score variables showed superior predictive ability for the mortality risk-stratification of septic patients presenting at the ED.

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