TY - JOUR
T1 - Predictors of heart rate variability and its prognostic significance in chronic kidney disease
AU - Chandra, Preeti
AU - Sands, Robin L.
AU - Gillespie, Brenda W.
AU - Levin, Nathan W.
AU - Kotanko, Peter
AU - Kiser, Margaret
AU - Finkelstein, Fredric
AU - Hinderliter, Alan
AU - Pop-Busui, Rodica
AU - Rajagopalan, Sanjay
AU - Saran, Rajiv
N1 - Funding Information:
Drs R.S., MD, and B.W.G., PhD, are members of the project ‘Establishing a Surveillance System for CKD’ supported under a cooperative agreement from the Centers for Disease Control and Prevention through grant number 5U36CD319276, AAMC ID number MM-1149-10/10.
Funding Information:
P.C., MD, is supported by a research fellowship from the National Kidney Foundation. These results have previously been presented in part at the American Society of Nephrology and National Kidney Foundation meetings in 2009 as poster presentations.
Funding Information:
Acknowledgements. The study was funded by the RRI, New York, NY. We are grateful to all study coordinators and Kerri Briesmiester, Project Manager, for training all the study coordinators in the Holter monitoring technique.
PY - 2012/2
Y1 - 2012/2
N2 - Background. Heart rate variability (HRV), a noninvasive measure of autonomic dysfunction and a risk factor for cardiovascular disease (CVD), has not been systematically studied in nondialysis chronic kidney disease (CKD). Methods. HRV was assessed using 24-h Holter monitoring in 305 subjects from the Renal Research Institute-CKD Study, a four-center prospective cohort of CKD (Stages 3-5). Multiple linear regression was used to assess predictors of HRV (both time and frequency domain) and Cox regression used to predict outcomes of CVD, composite of CVD/death and end-stage renal disease (ESRD). Results. A total of 47 CVD, 67 ESRD and 24 death events occurred over a median follow-up of 2.7 years. Lower HRV was significantly associated with older age, female gender, diabetes, higher heart rate, C-reactive protein and phosphorus, lower serum albumin and Stage 5 CKD. Lower HRV (mostly frequency domain) was significantly associated with higher risk of CVD and the composite end point of CVD or death. Significantly, lower HRV (frequency domain) was associated with higher risk of progression to ESRD, although this effect was relatively weaker.Conclusions.This study draws attention to the importance of HRV as a relatively under recognized predictor of adverse cardiovascular and renal outcomes in patients with nondialysis CKD. Whether interventions that improve HRV will improve these outcomes in this high-risk population deserves further study.
AB - Background. Heart rate variability (HRV), a noninvasive measure of autonomic dysfunction and a risk factor for cardiovascular disease (CVD), has not been systematically studied in nondialysis chronic kidney disease (CKD). Methods. HRV was assessed using 24-h Holter monitoring in 305 subjects from the Renal Research Institute-CKD Study, a four-center prospective cohort of CKD (Stages 3-5). Multiple linear regression was used to assess predictors of HRV (both time and frequency domain) and Cox regression used to predict outcomes of CVD, composite of CVD/death and end-stage renal disease (ESRD). Results. A total of 47 CVD, 67 ESRD and 24 death events occurred over a median follow-up of 2.7 years. Lower HRV was significantly associated with older age, female gender, diabetes, higher heart rate, C-reactive protein and phosphorus, lower serum albumin and Stage 5 CKD. Lower HRV (mostly frequency domain) was significantly associated with higher risk of CVD and the composite end point of CVD or death. Significantly, lower HRV (frequency domain) was associated with higher risk of progression to ESRD, although this effect was relatively weaker.Conclusions.This study draws attention to the importance of HRV as a relatively under recognized predictor of adverse cardiovascular and renal outcomes in patients with nondialysis CKD. Whether interventions that improve HRV will improve these outcomes in this high-risk population deserves further study.
KW - autonomic nervous system
KW - cardiovascular disease risk factors
KW - cardiovascular outcomes
KW - cohort study
KW - end-stage renal disease
UR - https://www.scopus.com/pages/publications/84856868389
U2 - 10.1093/ndt/gfr340
DO - 10.1093/ndt/gfr340
M3 - Article
C2 - 21765187
AN - SCOPUS:84856868389
SN - 0931-0509
VL - 27
SP - 700
EP - 709
JO - Nephrology Dialysis Transplantation
JF - Nephrology Dialysis Transplantation
IS - 2
ER -