Heart Rate Variability Predicts ESRD and CKD-Related Hospitalization
Heart Rate Variability Predicts ESRD and CKD-Related Hospitalization
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DOI：
10.1681/asn.2009111112
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发表时间：
2010-09-01
影响因子：
13.6
通讯作者：
Coresh, Josef
中科院分区：
文献类型：
--
作者：
Brotman, Daniel J.;Bash, Lori D.;Coresh, Josef
自主神经失衡是糖尿病和高血压的一个特征，可能导致不良的心血管结局。在动物模型中，交感神经活动会导致肾脏损伤，但在人类中自主神经功能障碍在慢性肾脏病（CKD）和终末期肾病（ESRD）发生之前的程度尚不清楚。我们在社区动脉粥样硬化风险（ARIC）研究中对13241名45 - 64岁的成年人进行了中位16年的随访，测量了他们的静息心率和心率变异性。我们按四分位数检查心率参数，将最低四分位数（分别按时域和频域测量）的人群定义为感兴趣的风险组。我们确定了199例新发ESRD病例和541例因CKD住院的患者；较高的静息心率和较低的心率变异性与这两种结局都相关。在心率最高四分位数的人群中，ESRD的完全调整后风险比为1.98（95%置信区间[CI]为1.45 - 2.70），高频功率的风险比为1.56（95%CI为1.14 - 2.14）。其他时域和频域测量指标与ESRD和CKD相关住院情况也有类似的显著相关性。这些结果表明，自主神经功能障碍可能是ESRD和CKD相关住院的一个重要危险因素，并呼吁进一步研究以确定这些关联背后的机制。
Autonomic imbalance, a feature of both diabetes and hypertension, may contribute to adverse cardiovascular outcomes. In animal models, sympathetic nerve activity contributes to renal damage but the extent to which autonomic dysfunction precedes the development of CKD and ESRD in humans is unknown. We measured resting heart rate and heart rate variability in 13,241 adults (45- to 64-years old) followed for a median of 16 years in the Atherosclerosis Risk in Communities (ARIC) Study. We examined heart rate parameters by quartiles, defining those in the lowest quartile (by time and frequency domain measures separately) as the risk group of interest. We identified 199 cases of incident ESRD and 541 patients with CKD-related hospitalizations; higher resting heart rate and lower heart rate variability associated with both outcomes. The fully adjusted hazard ratios for ESRD were 1.98 (95% confidence interval [CI] 1.45 to 2.70) among those in the highest heart rate quartile and 1.56 (95% CI 1.14 to 2.14) for high-frequency power. Other time and frequency domain measures were similarly and significantly associated with ESRD and CKD-related hospitalizations. These results suggest that autonomic dysfunction may be an important risk factor for ESRD and CKD-related hospitalizations and call for further studies to define the mechanisms that underlie these associations.