What is the clinical evidence from this study?

Study design: Observational. Population: Chronic kidney disease (n=52). Intervention: Holter monitoring for Heart Rate Variability vs. Different stages of CKD (III to VD). Primary outcome: SDNN (msec) across CKD stages III to VD on hemodialysis day (p=0.02).

May 26, 2020Open Access

Evaluation of role of heart rate variability with holter monitoring in chronic kidney disease

NANaveen Reddy AvulaDr. D. Y. Patil Medical College, Hospital and Research Centre TDTusahr DigheDr. D. Y. Patil Medical College, Hospital and Research Centre ASAtul SajgureSahyadri Hospital

Resultado clave

In patients with chronic kidney disease, heart rate variability parameters such as SDNN significantly decreased as the disease progressed, with the lowest values observed in stage VD on hemodialysis day (p=0.02).

Diseño del estudio

Tipo

Observational (n=52)

Multicéntrico

PICO estructurado

Does the stage of chronic kidney disease and presence of diabetes affect heart rate variability parameters?

Población

52 adults (>18 years) with known chronic kidney disease stage III to VD (eGFR ≤60ml/min/1.73m2)

Intervención

24-hour Holter monitoring

Comparador

Comparisons across different CKD stages (III to VD), hemodialysis vs. non-hemodialysis days, and diabetic vs. non-diabetic subjects

Resultado

Heart rate variability (HRV) parameters (including SDNN, SDNN Index, and P/S ratio)surrogate

Chronic kidney disease severity and concomitant diabetes significantly alter heart rate variability parameters, suggesting progressive autonomic imbalance.

Resultado numérico

Tasa de eventos absoluta: 61.23% vs 98.3%

valor p: p=0.02

Limitaciones

Single centered study with a small sample size
Not a long term follow up study to establish the association of autonomic dysfunction in CKD and its prognosis
Majority of subjects were on anti-hypertensive medication which could have affected the HRV

Resumen

Background: Chronic kidney disease is prevalent disease even in absence of diabetes and hypertension in 12% adults over 65 yrs of age. Autonomic imbalance is not studied in detail which could be a risk factor for chronic kidney disease.Methods: This Study was observational study in a tertiary care Hospital in pune, india and was conducted for a period of 1 year with sample size of 52. All subjects were known cases of chronic kidney disease from stage III to VD. All individuals of age >18yrs and eGFR ≤60ml/min/1.73m2 according to CKD- EPI equation were included in the study and who were not giving consent were excluded. 24 hrs Holter monitoring was done in stages from ckd stages III to V, for ckd stage VD on both Hemodialysis day and Non hemodialysis. Analysis was done using SPSS version 20 (IBM SPSS Statistics Inc., Chicago, Illinois, USA) Windows software program. The paired t test, analysis of variance (ANOVA) and Chi-square test were used. Level of significance was set at p≤0.05.Results: In this study when Heart rate variability (HRV) parameters were compared in different stages of ckd from stage III to VD (on Hemodialysis day) SDNN, SDNN Index were found to be statistically significant and on non Hemodialysis day SDNN Index was found to be statistically significant. In each subgroup of ckd stage V when diabetic subjects were compared with non-diabetic subjects, HRV parameters like ratio of P/S which was found to be low and significant in ckd stage V diabetic subjects.Conclusions: Chronic kidney disease itself can affect the HRV parameters. Causal relationship between HRV and chronic kidney diseases can be vice versa and further needs larger and prospective studies.

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