Predictors of heart rate variability and its prognostic significance in chronic kidney disease
Predictors of heart rate variability and its prognostic significance in chronic kidney disease
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DOI：
10.1093/ndt/gfr340
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发表时间：
2012-02-01
影响因子：
6.1
通讯作者：
Saran, Rajiv
中科院分区：
文献类型：
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作者：
Chandra, Preeti;Sands, Robin L.;Saran, Rajiv
心率变异性 (HRV) 是自主神经功能障碍的无创测量方法，也是心血管疾病 (CVD) 的危险因素，尚未在非透析慢性肾病 (CKD) 中进行系统研究。使用 24 小时动态心电图监测对来自肾脏研究所 CKD 研究的 305 名受试者进行评估，该研究是一项四中心 CKD 前瞻性队列（第 3-5 阶段）。多元线性回归用于评估 HRV（时域和频域）的预测因子，Cox 回归用于预测 CVD、CVD/死亡复合和终末期肾病 (ESRD) 的结果。在中位随访 2.7 年中，总共发生了 47 例 CVD、67 例 ESRD 和 24 例死亡事件。较低的 HRV 与年龄较大、女性、糖尿病、较高的心率、C 反应蛋白和磷、较低的血清白蛋白和 5 期 CKD 显着相关。较低的 HRV（主要是频域）与较高的 CVD 风险以及 CVD 或死亡的复合终点显着相关。值得注意的是，较低的 HRV（频域）与较高的进展为 ESRD 的风险相关，尽管这种影响相对较弱。这项研究提请人们注意 HRV 作为非透析 CKD 患者心血管和肾脏不良结局的相对未被认识的预测因子的重要性。改善 HRV 的干预措施是否会改善这一高危人群的这些结果值得进一步研究。
Heart rate variability (HRV), a noninvasive measure of autonomic dysfunction and a risk factor for cardiovascular disease (CVD), has not been systematically studied in nondialysis chronic kidney disease (CKD).HRV was assessed using 24-h Holter monitoring in 305 subjects from the Renal Research Institute-CKD Study, a four-center prospective cohort of CKD (Stages 3-5). Multiple linear regression was used to assess predictors of HRV (both time and frequency domain) and Cox regression used to predict outcomes of CVD, composite of CVD/death and end-stage renal disease (ESRD).A total of 47 CVD, 67 ESRD and 24 death events occurred over a median follow-up of 2.7 years. Lower HRV was significantly associated with older age, female gender, diabetes, higher heart rate, C-reactive protein and phosphorus, lower serum albumin and Stage 5 CKD. Lower HRV (mostly frequency domain) was significantly associated with higher risk of CVD and the composite end point of CVD or death. Significantly, lower HRV (frequency domain) was associated with higher risk of progression to ESRD, although this effect was relatively weaker.This study draws attention to the importance of HRV as a relatively under recognized predictor of adverse cardiovascular and renal outcomes in patients with nondialysis CKD. Whether interventions that improve HRV will improve these outcomes in this high-risk population deserves further study.