Heart rate variability helps predict rapid CKD decline

  • Chou YH & al.
  • Nephrology (Carlton)
  • 17 Oct 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Heart rate variability (HRV), over and above classical risk factors, can help predict rapid progression of chronic kidney disease (CKD).

Why this matters

  • Autonomic dysfunction is a common CKD morbidity; this study showed that prevalence measured by HRV is different with each stage.
  • Estimation of ln(low-frequency [LF] power)/ln(high-frequency [HF] power)—InLF/HF—by ECG is noninvasive and easily performed.

Study design

  • Prospective observational study evaluating the prognostic significance of HRV on renal function in 326 patients (mean age, 57.89±8.71 years) with nondialysis CKD, followed for a median of 2.02 years.
  • 137 patients (42.0%) experienced rapid CKD progression.
  • Funding: Mrs. Hsiu-Chin Lee Kidney Research Foundation; National Taiwan University Hospital.

Key results

  • HRV abnormality increased with CKD severity; in stage 5 CKD, the proportion of patients with abnormal InLF, InHF, and InLF/HF was 66.7%, 47.2%, and 27.8%, respectively.
  • CKD severity correlated negatively with InLF (β, –0.13; P=.04) and InHF (β, –0.13; P=.049).
  • Univariate factors for HRV included advanced CKD, diabetes, serum albumin, severe proteinuria, Beck Anxiety Inventory score, erythropoietin use, renin-angiotensin system inhibitors, and heart failure.
  • Multivariate analysis identified 3 factors for rapid CKD progression: lower InLF/HF (aOR=0.07; P<.0001 hypertension p=".014)," and severe proteinuria>

Limitations

  • Lack of ECG verification by traditional methods.

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