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      Heart Rate Variability Correlates to Functional Aerobic Impairment in Hemodialysis Patients

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          Abstract

          Background

          Autonomic dysfunction (AD) is highly prevalent in hemodialysis (HD) patients and has been implicated in their increased risk of cardiovascular mortality.

          Objective

          To correlate heart rate variability (HRV) during exercise treadmill test (ETT) with the values obtained when measuring functional aerobic impairment (FAI) in HD patients and controls.

          Methods

          Cross-sectional study involving HD patients and a control group. Clinical examination, blood sampling, transthoracic echocardiogram, 24-hour Holter, and ETT were performed. A symptom-limited ramp treadmill protocol with active recovery was employed. Heart rate variability was evaluated in time domain at exercise and recovery periods.

          Results

          Forty-one HD patients and 41 controls concluded the study. HD patients had higher FAI and lower HRV than controls (p<0.001 for both). A correlation was found between exercise HRV (SDNN) and FAI in both groups. This association was independent of age, sex, smoking, body mass index, diabetes, and clonidine or beta-blocker use, but not of hemoglobin levels.

          Conclusion

          No association was found between FAI and HRV on 24-hour Holter or at the recovery period of ETT. Of note, exercise HRV was inversely correlated with FAI in HD patients and controls.

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          Most cited references34

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          Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome).

          P Stenvinkel, O Heimbürger, B. Lindholm … (2000)
          Article 0 comments Cited 167 times – based on 0 reviews     Review now
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            Sudden cardiac death and dialysis patients.

            Charles Herzog, J Mangrum, Rod Passman (2015)
            Dialysis patients have extraordinarily high mortality rates. The death rate for all US dialysis patients in 2004 was 230 per 1000 patient-years. Cardiac disease is the major cause of death in dialysis patients and accounts for 43% of all-cause mortality. In the United States Renal Data System database 62% of cardiac deaths (or 27% of all deaths) are attributable to arrhythmic mechanisms. The estimated rate of sudden cardiac death in US dialysis patients in 2002 was 7% per year. There are several plausible explanations for the special vulnerability of dialysis patients to sustaining sudden cardiac death. Obstructive coronary artery disease, coupled with diminished tolerance to myocardial ischemia (in the setting of myocardial fibrosis and left ventricular hypertrophy), rapid electrolyte shifts in hemodialysis patients, and derangements in autonomic function may all contribute to this heightened risk of sudden cardiac death. This review focuses on the epidemiology of sudden cardiac death in dialysis patients, underlying mechanisms of sudden death, and potential interventions to reduce the risk of sudden cardiac death in dialysis patients (including medical therapy and defibrillators). It is unlikely that one single therapeutic intervention will prevent sudden cardiac death in dialysis patients; but a more modest (and attainable) goal is the implementation of multiple strategies to reduce the risk of sudden cardiac death in this special high-risk population.
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              Cardiorespiratory fitness is related to the risk of sudden cardiac death: a population-based follow-up study.

              Kimmo Ronkainen, Rainer Rauramaa, Sudhir Kurl … (2010)
              Our aim was to examine the relation of cardiorespiratory fitness with sudden cardiac death (SCD) in a population-based sample of men. Very limited information is available about the role of cardiorespiratory fitness in the prediction of SCD. This population study was based on 2,368 men 42 to 60 years of age. Cardiorespiratory fitness was defined by using respiratory gas exchange analyzer and maximal workload during cycle ergometer exercise test. During the 17-year follow-up, there were 146 SCDs. As a continuous variable, 1 metabolic equivalent (MET) increment in cardiorespiratory fitness was related to a decrease of 22% in the risk of SCD (relative risk: 0.78, 95% confidence interval: 0.71 to 0.84, p<0.001). In addition to cardiorespiratory fitness, ischemic ST-segment depression during exercise testing, smoking, systolic blood pressure, prevalent coronary heart disease, family history of coronary heart disease, and type 2 diabetes mellitus were related to the risk of SCD. The Harrell C-index for the total model discrimination was 0.767, while cardiorespiratory fitness provides modest improvement (from 0.760 to 0.767) in the risk prediction when added with all other risk factors. The integrated discrimination improvement was 0.0087 (p=0.018, relative integrated discrimination improvement 0.11) when cardiorespiratory fitness was added in the model. However, the net reclassification index (-0.018) was not statistically significantly improved (p=0.703). Cardiorespiratory fitness is a predictor of SCD in addition to that predicted by conventional risk factors. There was a slight improvement in the level of discrimination, although the net reclassification index did not change while using cardiorespiratory fitness with conventional risk factors. Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arq Bras Cardiol
                Journal ID (iso-abbrev): Arq. Bras. Cardiol
                Title: Arquivos Brasileiros de Cardiologia
                Publisher: Sociedade Brasileira de Cardiologia
                ISSN (Print): 0066-782X
                ISSN (Electronic): 1678-4170
                Publication date (Print and electronic): June 2015
                Publication date (Print): June 2015
                Volume: 104
                Issue: 6
                Pages: 493-500
                Affiliations
                [1 ]Universidade Federal Fluminense, Department of Cardiology, Rio de Janeiro, RJ - Brazil Mailing
                [2 ]Universidade Federal Fluminense, Department of Nephrology, Rio de Janeiro, RJ - Brazil Mailing
                Author notes
                Mailing Address: Maria Angela Magalhães de Queiroz Carreira , Rua Arroio Fundo, 230, Anil. Postal Code 22765-260, Rio de Janeiro, RJ – Brazil E-mail: macarreira@ 123456globo.com
                Article
                DOI: 10.5935/abc.20150039
                PMC ID: 4484682
                PubMed ID: 26131705
                SO-VID: d1061a6a-ecad-4f0f-a77c-967b8faa5d14
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 12 September 2014
                Date revision received : 14 January 2015
                Date accepted : 19 January 2015
                Categories
                Subject: Original Article

                Keywords: sympathetic nervous system / physiopathology,exercise test,renal dialysis,mortality,exercise
                Data availability:
                Keywords: sympathetic nervous system / physiopathology, exercise test, renal dialysis, mortality, exercise

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