HDCN Abstract:  ASN Annual Meeting -- San Diego  

Chandra P, Sands R, Gillespie B, et al.

Prognostic Value of Heart Rate Variability (HRV) in Chronic Kidney Disease (CKD): The Renal Research Institute (RRI)-CKD Study.

ASN Annual Meeting -- San Diego
J Am Soc Nephrol (Nov) 20:395A 2009

CKD patients have a high cardiovascular disease (CVD) burden. HRV, a noninvasive measure of autonomic function and CV risk, has not been well studied in non-dialysis CKD patients.
Time (SDNN) and frequency (LF/HF ratio) domain measures of HRV (higher=better) were evaluated using 24-hr Holter in a subset of patients (n=305) from the RRI-CKD Study (CKD stages 3- 5), a 4-center prospective cohort study. Predictors of HRV were assessed using multiple linear regression, adjusted for case-mix. Cox regression was used to test SDNN and LF/HF ratio as predictors of CV events/procedures (MI, CVA, CABG, etc.).

Mean age was 59.5 14.7 yr, 51% were men, and 78% white. Diabetes mellitus (DM) was present in 31%; hypertension in 89%, history of (h/o) CVD in 37%. There were 47 CV events. The table shows selected HRV variables by CV event & CKD stage.

In multivariable analysis, SDNN was significantly lower (p <0.05) in women, non-whites, in those with DM, lower albumin, higher CRP, and those on calcium channel blockers. LF/HF ratio was significantly lower in older patients, women, those with DM, higher phosphorus and on diuretics. Both domains of HRV were significantly lower in patients with CKD Stage 5 compared to those with Stages 3 or 4 in unadjusted but not multivariable analysis. Higher LF/HF ratio, but not SDNN, was associated with lower risk of a CV event after adjustment for age, gender, DM, & h/o CV event (HR: 0.71, p=0.0018).

LF/HF ratio was a strong predictor of CV events. The assessment of HRV in addition to traditional predictors of CVD in this population could potentially aid in identifying high risk patients. The mechanisms underlying HRV abnormalities in CKD warrant further study.

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