Association of cardiac autonomic neuropathy assessed by heart rate response during exercise with intradialytic hypotension and mortality in hemodialysis patients
Association of cardiac autonomic neuropathy assessed by heart rate response during exercise with intradialytic hypotension and mortality in hemodialysis patients
复制标题
通过运动时心率反应评估心脏自主神经病变与血液透析患者透析中低血压和死亡率的关系
DOI：
10.1016/j.kint.2022.01.032
复制
发表时间：
2022
影响因子：
19.6
通讯作者：
Suzuki Yusuke
中科院分区：
文献类型：
--
作者：
Usui Naoto;Nakata Junichiro;Uehata Akimi;Ando Shuji;Saitoh Masakazu;Kojima Sho;Inatsu Akihito;Hisadome Hideki;Suzuki Yusuke
心率（HR）反映了自主神经系统的动态行为，运动试验期间的HR曲线提供了预后信息。然而，在血液透析患者中没有这些因素的报道。对256例患者（平均年龄68.8岁）进行运动试验的数据进行了统计分析。评估患者在峰值运动时HR的HR储备百分比，峰值运动后1分钟的HR恢复，运动能力以及透析中低血压（IDH）。变时性功能不全（96.1%）（定义为HR储备低于80%）和HR恢复异常（60.5%）（定义为低于12次）的患病率非常常见。在随访期间（中位数，3.8年）发生了84例死亡。心率在7次以下缓慢恢复与校正后IDH相关（比值比2.7，95%置信区间1.1-6.4）。校正后，心率恢复低于12次（研究期间风险比为5.1，95%置信区间为2.5-10.5）、心率储备低于26.2%（3.4，1.7-6.8）和IDH（1.7，1.1-2.8）与全因死亡率相关。考虑到所有三个变量的混杂因素，只有12次心跳下的HR恢复与全因和原因特异性死亡率（“心血管”和“非心血管”）相关。即使在基于糖尿病和心血管疾病的亚组分析中，这种关联也是一致的。因此，运动期间的HR曲线可以反映血液透析患者中与心脏自主神经病变相关的潜在健康状况，这些疾病影响IDH及其生存率。
The heart rate (HR) reflects the dynamic behavior of the autonomic nervous system, and HR profiles during the exercise test provide prognostic information. However, there are no reports of these factors in hemodialysis patients. Data from 256 patients (mean 68.8 years old) who underwent an exercise test were statistically analyzed. Patients were evaluated for the percent HR reserve from HR at peak exercise, HR recovery for one minute after peak exercise, and exercise capacity, as well as intradialytic hypotension (IDH). The prevalence of chronotropic incompetence (96.1%), defined as under 80% HR reserve, and abnormal HR recovery (60.5%), defined as under 12 beats, were very common. Eighty-four deaths occurred during the follow-up period (median, 3.8 years). A slow HR recovery under 7 beats was associated with IDH after adjustment (odds ratio 2.7, 95% confidence interval 1.1–6.4). HR recovery under 12 beats (hazard ratio over study period 5.1, 95% confidence interval 2.5–10.5), HR reserve under 26.2% (3.4, 1.7–6.8), and IDH (1.7, 1.1–2.8) were associated with all-cause mortality after adjustment. Considering the confounding of all three variables, only HR recovery under 12 beats remained associated with the all-cause and cause-specific mortality (“cardiovascular” and “non-cardiovascular”). This association was consistent even in subgroup analyses based on the presence of diabetes and cardiovascular disease. Thus, HR profiles during the exercise can reflect potential health conditions related to cardiac autonomic neuropathy in hemodialysis patients that affect IDH and their survival.