NDT Advance Access originally published online on November 14, 2007
Nephrology Dialysis Transplantation 2008 23(2):444-449; doi:10.1093/ndt/gfm634
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Heart rate variability (HRV) in kidney failure: measurement and consequences of reduced HRV
1Renal-Electrolyte Division, University of Pittsburgh Medical Center, A909 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA, 2Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburgh, PA 15213, USA and 3Renal, University of Toronto, Toronto, Ontario, Canada
Correspondence and offprint requests to: Mark Unruh, Tel: +1-412-647-2561; Fax: +1-412-647-6891; E-mail: unruh{at}pitt.edu
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Abstract |
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A common cause of death in end-stage renal disease (ESRD) patients on dialysis is sudden cardiac death (SCD). Compared to the general population, the percentage of cardiovascular deaths that are attributed to SCD is higher in patients treated by dialysis. While coronary artery disease (CAD) is the predominant cause of SCD in dialysis patients, reduced heart rate variability (HRV) may play a role in the higher risk of SCD among other risk factors. HRV refers to beat-to-beat alterations in heart rate as measured by periodic variation in the R–R interval. HRV provides a non-invasive method for investigating autonomic input into the heart. It quantifies the amount by which the R–R interval or heart rate changes from one cardiac cycle to the next. The autonomic nervous system transmits impulses from the central nervous system to peripheral organs and is responsible for controlling the heart rate, blood pressure and respiratory activity. In normal individuals, without cardiac disease, the heart rate has a high degree of beat-to-beat variability. HRV fluctuates with respiration: it increases with inspiration and decreases with expiration and is primarily mediated by parasympathetic activity. HRV has been used to evaluate and quantify the cardiac risk associated with a variety of conditions including cardiac disorders, stroke, multiple sclerosis and diabetes. In this narrative review, we will examine the association between HRV and SCD. This report explains the measurement of HRV and the consequences of reduced HRV in the general population and dialysis patients. Lastly, this review will outline the possible use of HRV as a clinical predictor for SCD in the dialysis population. The current understanding of SCD based on HRV findings among the ESRD population support the use of more aggressive treatment of CAD; greater use of angiotensin converting enzyme inhibitor (ACE-i)/angiotensin receptor blockers (ARBs) and β-blockers and more frequent and/or nocturnal haemodialysis to improve the survival of a patient with kidney failure.
Keywords: end-stage renal disease (ESRD); heart rate variability (HRV); sudden cardiac death (SCD)
Received for publication: 10. 7.07
Accepted in revised form: 20. 8.07
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  C. T. Chan Heart rate variability in patients with end-stage renal disease: an emerging predictive tool for sudden cardiac death? Nephrol. Dial. Transplant., October 1, 2008; 23(10): 3061 - 3062. [Full Text] [PDF]
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P. Strozecki, G. Polak, and J. Manitius Heart rate variability (HRV) in kidney failure: measurement and consequences of reduced HRV Nephrol. Dial. Transplant., August 26, 2008; (2008) gfn481v1. [Full Text] [PDF]
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