A detrended fluctuation analysis (DFAα1) ≥ 0.95 was associated with a significantly lower risk of total mortality (HR 0.109) in patients with end-stage renal disease receiving peritoneal dialysis.
Cohort (n=132)
No
Does detrended fluctuation analysis (DFA) of heart rate dynamics predict cardiac and total mortality in patients with end-stage renal disease receiving peritoneal dialysis?
Cardiac autonomic dysfunction evaluated by short-term detrended fluctuation analysis (DFAα1) is a strong, independent predictor of cardiac and total mortality in ESRD patients on peritoneal dialysis.
Effect estimate: HR 0.109 (95% CI 0.033-0.362)
p-value: p=0.0003
BACKGROUND AND OBJECTIVES: Patients with severe kidney function impairment often have autonomic dysfunction, which could be evaluated noninvasively by heart rate variability (HRV) analysis. Nonlinear HRV parameters such as detrended fluctuation analysis (DFA) has been demonstrated to be an important outcome predictor in patients with cardiovascular diseases. Whether cardiac autonomic dysfunction measured by DFA is also a useful prognostic factor in patients with end-stage renal disease (ESRD) receiving peritoneal dialysis (PD) remains unclear. The purpose of the present study was designed to test the hypothesis. MATERIALS AND METHODS: Patients with ESRD receiving PD were included for the study. Twenty-four hour Holter monitor was obtained from each patient together with other important traditional prognostic makers such as underlying diseases, left ventricular ejection fraction (LVEF) and serum biochemistry profiles. Short-term (DFAα1) and long-term (DFAα2) DFA as well as other linear HRV parameters were calculated. RESULTS: A total of 132 patients (62 men, 72 women) with a mean age of 53.7±12.5 years were recruited from July 2007 to March 2009. During a median follow-up period of around 34 months, eight cardiac and six non-cardiac deaths were observed. Competing risk analysis demonstrated that decreased DFAα1 was a strong prognostic predictor for increased cardiac and total mortality. ROC analysis showed that the AUC of DFAα1 (<0.95) to predict mortality was 0.761 (95% confidence interval (CI). = 0.617-0.905). DFAα1≧ 0.95 was associated with lower cardiac mortality (Hazard ratio (HR) 0.062, 95% CI = 0.007-0.571, P = 0.014) and total mortality (HR = 0.109, 95% CI = 0.033-0.362, P = 0.0003). CONCLUSION: Cardiac autonomic dysfunction evaluated by DFAα1 is an independent predictor for cardiac and total mortality in patients with ESRD receiving PD.
Chiang et al. (Mon,) conducted a cohort in End-Stage Renal Disease receiving Peritoneal Dialysis (n=132). DFAα1 ≥ 0.95 vs. DFAα1 < 0.95 was evaluated on Total mortality (HR 0.109, 95% CI 0.033-0.362, p=0.0003). A detrended fluctuation analysis (DFAα1) ≥ 0.95 was associated with a significantly lower risk of total mortality (HR 0.109) in patients with end-stage renal disease receiving peritoneal dialysis.