Shiba M, Joki N, Nakamura M, et al.
Utility of Heart Rate Variability To Identfy High Risk Subset for
Cardiovascular Disease among Patients with Chronic Kidney Disease.
ASN Annual Meeting -- San Diego
J Am Soc Nephrol
(Nov) 20:394A 2009

Background: Chronic kidney disease (CKD) is well known as a risk
factor for cardiovascular disease. However, relationship between those
diseases is unclear. Sympathetic nerve hyperactivity in patient with CKD was
reported. Therefore, we studied heart rate variability (HRV) to understand
their cardiac autonomic nerve (CAN) status, and investigated the influence of
it on long-term result.
Methods; We analyzed 81 cases of 24-
hour recorded electrocardiograms among CKD (
eGFR
60ml/min/1.73m
by MDRD) patients who felt chest
discomfort. Patients with hemodialysis were excluded. HRV was assessed by
SDNN (standard deviation of normal to normal RR intervals; msec), LF (low
frequency; ms
) and HF (high frequency; ms
) component. We divided them into the two groups
according to the value of SDNN (<100,reduced: r-SDNN or
100,preserved: p-SDNN), and we investigated the occurrence of major
adverse cardiovascular event (MACE; cardiovascular death, non-fetal
myocardial infarction, congestive heart failure, and stroke) during follow-up
periods.
Results; There were 21 patients (26.0%) with r-
SDNN.Decreased ln HF (3.69 vs. 4.89ms
,P=0.001)
and ln LF (3.98 vs. 5.49ms
, P<0.001) were
seen in the r-SDNN group compared with p-SDNN group. The r-SDNN group had
higher rate of MACE during follow-up period.

By multivariate analysis, independent predictor of MACE is r-
SDNN (Hazard ratio,6.72; 95%CI,1.28-35.2; P=0.024). Conclusion: CAN
dysfunction revealed by reduced HRV was seen in 26% of CKD patients.
Combination of CKD and reduced HRV associated with poor prognosis. We may be
able to identify the high risk patient for cardiovascular event among
patients with CKD.

© Copyright 2009-2010 American Society of
Nephrology.Reproduced with permission.
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