Nephrology Dialysis Transplantation, Vol 14, Issue 6 1480-1488, Copyright © 1999 by Oxford University Press
J Hayano, H Takahashi, T Toriyama, S Mukai, A Okada, S Sakata, A Yamada, N Ohte and H Kawahara
Background: Mortality is high in chronic haemodialysis
patients with cardiovascular disease, and many of them die suddenly.
Reduced heart rate variability (HRV) is an increased risk for death in
various populations, but its prognostic value in haemodialysis patients
remains uninvestigated. Methods: We analysed the
associations between 24-h HRV measures and long-term mortality through a
prospective follow-up of 31 chronic haemodialysis patients who underwent
diagnostic coronary angiopathy. Results: Of the 31
patients, at baseline, seven had a previous myocardial infarction, five had
a history of congestive heart failure and 14 had significant (⩾75%)
coronary stenosis (four had multi-vessel stenosis). During follow-up for 60
± 5 months, 14 patients died, 11 of them suddenly. A left
ventricular ejection fraction of <0.45, multi-vessel coronary
stenosis, ventricular tachycardia on 24-h ECG and decreased/abnormal 24-h
HRV (triangular index <22 and abnormal Poincare plot) carried a
univariate risk of all-cause death, while the risk of sudden death was only
correlated with decreased HRV (standard deviation of normal-normal R-R
interval <50 ms, triangular index <22 and ultra-low frequency
power <8.7 ln(ms2)). Multivariate analysis
revealed that a triangular index <22 was the best predictor of
increased risk for both all-cause and sudden death (hazards ratio (95% CI);
8.1 (1.3-48.6) and 12.6 (1.3-126.4), respectively) and that the association
was independent of cardiac function, macrovascular diseases, ventricular
arrhythmias and cardiovascular risk factors. The 5-year mortality when the
triangular index was ⩽22 or <22 was 33 or 88% for patients
with coronary artery disease and 0 or 50% for those without.
Conclusions: These results indicate that HRV has an
independent prognostic value in chronic haemodialysis patients and
identifies an increased risk for all-cause and sudden death. Key
words: ambulatory electrocardiography; coronary artery disease;
heart rate variability; haemodialysis; prospective study; sudden cardiac
death
ORIGINAL ARTICLES
Prognostic value of heart rate variability during long-term follow-up in chronic haemodialysis patients with end-stage renal disease
Third Department of Internal Medicine, Nagoya City University Medical School, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya 467-8601, Japan; Department of Hemodialysis Treatment and Department of Internal Medicine, Nagoya Kyoritsu Hospital, Nagoya, Japan; Corresponding author
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  R. Ranpuria, M. Hall, C. T. Chan, and M. Unruh Heart rate variability (HRV) in kidney failure: measurement and consequences of reduced HRV Nephrol. Dial. Transplant., February 1, 2008; 23(2): 444 - 449. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Paoletti, C. Specchia, G. Di Maio, D. Bellino, B. Damasio, P. Cassottana, and G. Cannella The worsening of left ventricular hypertrophy is the strongest predictor of sudden cardiac death in haemodialysis patients: a 10 year survey Nephrol. Dial. Transplant., July 1, 2004; 19(7): 1829 - 1834. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Liu, H. Takahashi, Y. Morita, S. Maruyama, M. Mizuno, Y. Yuzawa, M. Watanabe, T. Toriyama, H. Kawahara, and S. Matsuo Non-dipping is a potent predictor of cardiovascular mortality and is associated with autonomic dysfunction in haemodialysis patients Nephrol. Dial. Transplant., March 1, 2003; 18(3): 563 - 569. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Fukuta, J. Hayano, S. Ishihara, S. Sakata, S. Mukai, N. Ohte, K. Ojika, K. Yagi, H. Matsumoto, S. Sohmiya, et al. Prognostic value of heart rate variability in patients with end-stage renal disease on chronic haemodialysis Nephrol. Dial. Transplant., February 1, 2003; 18(2): 318 - 325. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Espinosa, A. Martin-Malo, M. A. A. de Lara, and P. Aljama Risk of death and liver cirrhosis in anti-HCV-positive long-term haemodialysis patients Nephrol. Dial. Transplant., August 1, 2001; 16(8): 1669 - 1674. [Abstract] [Full Text] [PDF]
|
|