Key result
Among hemodialysis patients, diabetes mellitus was associated with an 18% lower standard deviation of the R-R interval (95% CI -26 to -8) compared to those without diabetes.
Why the study?
Autonomic dysfunction is common in patients with DM receiving hemodialysis and may increase intra-dialytic hypotension risk, but the relationship between DM, HRV, and intra-HD SBP required exploration.
Is diabetes mellitus associated with reduced heart rate variability and intra-dialytic hypotension in patients receiving hemodialysis?
Observational (n=198)
Is diabetes mellitus associated with reduced heart rate variability and intra-dialytic hypotension in patients receiving hemodialysis?
In hemodialysis patients, diabetes is associated with lower overall heart rate variability (SDNN), though this autonomic dysfunction does not appear to mediate intra-dialytic hypotension.
Background: Autonomic dysfunction is common among patients with diabetes mellitus (DM) receiving hemodialysis (HD) and may contribute to a higher risk of intra-dialytic hypotension. We explored the association of DM with heart rate variability (HRV; a surrogate of dysautonomia) and explored if HRV modified the relation between DM and intra-HD systolic blood pressure (SBP). Methods: In a post hoc analysis of the Frequent Hemodialysis Network Daily Trial, we used: 1) random effects linear regression to estimate the association of DM (vs. none) with log-transformed low-frequency power [LF], high-frequency power [HF], LF/HF, and standard deviation of the R-R interval [SDNN] measured on a per-visit basis (baseline and 12-months); 2) linear regression to explore associations with changes in HRV parameters over 12 months. We performed mediation analyses to explore if the association of DM with intra-HD SBP was related to HRV. Models adjusted for age, sex, designated race, height, access, HD vintage, heart failure, pre-HD SBP, heart rate, ultrafiltration rate, hemoglobin, albumin, calcium blockers, diuretics, LV mass, and randomized treatment. Results: Of patients with available data and without atrial fibrillation (n=198), 82 (41%) had DM. Median values for HRV parameters at baseline and 12 months are shown in Table 1. In adjusted random effects models, DM (vs. none) was not significantly associated with differences in LF 9% (95%CI -18, 46), HF 9% (95%CI -10, 32), or LF/HF -1% (95%CI -16,17), but was significantly associated with SDNN -18% (95%CI -26, -8). DM was not associated with a change from baseline to 12 months in any HRV parameter. In mediation analyses, HRV was estimated to mediate -8% (95%CI -52, 15) of the association between DM and nadir SBP. Conclusion: DM (vs. none) was associated with 18% lower SDNN, a surrogate of overall heart rate variability, among participants of FHN on a per-session level. SDNN does not appear to mediate the association of DM with intra-dialytic nadir SBP.
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Moloney et al. (2024) conducted an observational in Hemodialysis (n=198). Diabetes mellitus vs. No diabetes mellitus was evaluated on Standard deviation of the R-R interval (SDNN) (-18% difference, 95% CI -26 to -8). Among hemodialysis patients, diabetes mellitus was associated with an 18% lower standard deviation of the R-R interval (95% CI -26 to -8) compared to those without diabetes.
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