Heart Rate Variability Predicts Major Adverse Cardiovascular Events and Hospitalization in Maintenance Hemodialysis Patients

• Published in: Kidney & blood pressure research 2017-01, Vol.42 (1), p.76-88
• Main Authors: Huang, Jiun-Chi, Kuo, I-Ching, Tsai, Yi-Chun, Lee, Jia-Jung, Lim, Lee-Moay, Chen, Szu-Chia, Chiu, Yi-Wen, Chang, Jer-Ming, Chen, Hung-hun
• Format: Article
• Language: English
• Subjects: Aged; Angina pectoris; Angiotensin; Angiotensin II; Angiotensin-converting enzyme inhibitors; Autonomic nervous system; Biomarkers; Calcium; Calcium (blood); Cardiac arrhythmia; Cardiovascular disease; Cardiovascular Diseases - complications; Cholesterol; Cohort Studies; Confidence intervals; Coronary artery; Coronary artery disease; Creatinine; Diabetes; Dialysis; Enzyme inhibitors; Enzymes; Female; Heart diseases; Heart failure; Heart rate; Heart Rate - physiology; Heart rate variability; Hemodialysis; Hospitalization; Hospitals; Humans; Inflammation; Kidney diseases; Laboratories; Major adverse cardiovascular events; Male; Medical records; Metabolism; Middle Aged; Mortality; Original Paper; Patients; Peptidyl-dipeptidase A; Phosphorus; Predictive maintenance; Prognosis; Prospective Studies; Proteins; Regression analysis; Renal Dialysis; Risk Factors; Serum albumin; Signal processing; Statistical analysis; Studies; Ultrafiltration; Variability; Very Low Frequencies; Very low frequency
• ISSN: 1420-4096; 1423-0143
• DOI: 10.1159/000469716

Background/Aims: Heart rate variability (HRV) has been linked to mortality in maintenance hemodialysis (HD) patients, but it is less clear whether HRV is associated with major adverse cardiovascular events (MACEs) and hospitalization. Methods: This study enrolled 179 maintenance HD patients. HRV was measured to assess its prognostic significance in relation to MACEs and hospitalization. Results: During the follow-up period of 33.3 ± 6.7 months, 36 (20.1%) patients had a MACE, and 98 (54.7%) experienced hospitalization. In multivariate adjusted Cox regression analysis, low very low frequency (VLF) power (hazard ratio [HR], 0.727; 95% confidence interval [CI], 0.624–0.848; p < 0.001), a history of coronary artery disease, high ultrafiltration rate, the use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and the use of beta-blockers were all significantly associated with MACEs. Low VLF power (HR, 0.873; 95% CI, 0.785–0.971; p = 0.012), low serum albumin, low serum creatinine, low Kt/V levels, and high serum calcium-phosphorus product levels significantly predicted hospitalization in maintenance HD patients. Conclusions: Reduced VLF power is linked to an increased risk of MACEs and hospitalization in maintenance HD patients. Assessing cardiac autonomic function through HRV is of pivotal prognostic significance for this patient population.