Heart rate variability as a predictor of rapid renal function deterioration in chronic kidney disease patients

被引:23
作者
Chou, Yu-Hsiang [1 ,4 ,9 ]
Huang, Wei-Lieh [5 ,6 ,11 ]
Chang, Chin-Hao [2 ]
Yang, Cheryl C. H. [8 ]
Kuo, Terry B. J. [8 ,10 ]
Lin, Shuei-Liong [1 ,3 ,4 ,7 ]
Chiang, Wen-Chih [1 ]
Chu, Tzong-Shinn [1 ]
机构
[1] Natl Taiwan Univ Hosp, Dept Internal Med, Renal Div, 7 Zhongshan S Rd, Taipei 100, Taiwan
[2] Natl Taiwan Univ Hosp, Dept Med Res, Taipei, Taiwan
[3] Natl Taiwan Univ Hosp, Dept Integrated Diagnost & Therapeut, Taipei, Taiwan
[4] Natl Taiwan Univ, Coll Med, Grad Inst Physiol, Taipei, Taiwan
[5] Natl Taiwan Univ, Coll Med, Dept Psychiat, Taipei, Taiwan
[6] Natl Taiwan Univ, Grad Inst Clin Med, Taipei, Taiwan
[7] Natl Taiwan Univ, Res Ctr Dev Biol & Regenerat Med, Taipei, Taiwan
[8] Natl Yang Ming Univ, Inst Brain Sci, Taipei, Taiwan
[9] Natl Taiwan Univ Hosp, Jin Shan Branch, Dept Internal Med, New Taipei, Taiwan
[10] Natl Cent Univ, Inst Translat & Interdisciplinary Med, Taoyuan, Taiwan
[11] Natl Taiwan Univ Hosp, Yunlin Branch, Dept Psychiat, Douliu City, Yunlin, Taiwan
关键词
autonomic dysfunction; chronic kidney disease; heart rate variability; renal function progression; CARDIOVASCULAR RISK-FACTORS; AUTONOMIC DYSFUNCTION; SYMPATHETIC ACTIVITY; SPECTRAL-ANALYSIS; NEURAL-CONTROL; COMPLICATIONS; ASSOCIATION; POPULATION; NEUROPATHY;
D O I
10.1111/nep.13514
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Aim Autonomic dysfunction contributes to cardiovascular morbidity/mortality and can be evaluated with heart rate variability (HRV). This study is to evaluate the prognostic significance of HRV on renal function in non-dialysis chronic kidney disease (CKD) patients. Methods We enrolled 326 non-dialysis CKD patients in this prospective observational study. The median follow-up period was 2.02 years. Five-minutes of electrocardiography recordings obtained at enrolment were reprocessed to assess HRV. Five frequency-domain measures and one time-domain measures were obtained. Rapid CKD progression was defined as annual estimated glomerular filtration rate (eGFR) loss over 30% per year or eGFR decline rate over 3 mL/min per 1.73 m(2) per year. The prevalence of abnormal HRV, associated factors of HRV and impact of HRV on the risk of CKD progression were analyzed. Results The abnormality of HRV increased along with the severity of CKD. In patients with stage 5 CKD, the proportion of abnormal ln(low frequency power) (LF), ln(high frequency power) (HF), lnLF/HF were 69.5, 52.8 and 50%, respectively. Associated factors of HRV included advanced CKD, diabetes mellitus, serum albumin, severe proteinuria, Beck Anxiety Inventory score, erythropoietin use, renin-angiotensin system inhibitors and heart failure. Multivariate logistic regression model analysis revealed lower lnLF/HF, hypertension and severe proteinuria were the risk factors of rapid CKD progression. Conclusion The prevalence of autonomic dysfunction measured by HRV among each stage CKD patients is different. Most patients in advanced CKD stage have reduced values of HRV parameters. The estimation of lnLF/HF also provided prognostic information on CKD progression in addition to classical risk factors.
引用
收藏
页码:806 / 813
页数:8
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