December 10, 2021Journal of the American Heart AssociationOpen Access

Role of Heart Rate Variability in Association Between Glomerular Hyperfiltration and All‐Cause Mortality

View Full Paper

Ask AI

Bookmark

Why the study?

Glomerular hyperfiltration is paradoxically associated with increased cardiovascular events in healthy individuals, but the pathogenesis remains unclear.

Is glomerular hyperfiltration associated with increased all-cause mortality and reduced heart rate variability in individuals without prior cardiovascular events?

Structured PICO

Is glomerular hyperfiltration associated with increased all-cause mortality and reduced heart rate variability in individuals without prior cardiovascular events?

Population

1615 participants without prior cardiovascular events, mean age 66.1±17.3 years, 61.9% men.

Intervention

Glomerular hyperfiltration (GHF) defined as estimated glomerular filtration rate >the 95th percentile after stratification for age and sex

Comparator

Normal filtration (25th to 75th percentiles)

Outcome

All-cause mortality at 2 yearshard clinical

Glomerular hyperfiltration is associated with increased all-cause mortality, and this relationship may be mediated by autonomic dysfunction as evidenced by reduced heart rate variability.

Implication

GHF-mortality link via reduced HRV is hypothesis-generating; leaves open whether targeting autonomic function alters outcomes in prospective cohorts.

Abstract

Background Glomerular hyperfiltration (GHF) is paradoxically associated with increased cardiovascular events in healthy individuals, but the pathogenesis remains unclear. We aim to investigate whether GHF is associated with mortality and whether decreased heart rate variability (HRV) is associated with GHF. Methods and Results We retrospectively analyzed 1615 participants (aged 66.1±17.3 years, 61.9% men) without prior cardiovascular events. The glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation. GHF was defined as glomerular filtration rate >the 95th percentile after stratification for age and sex, whereas normal filtration was defined as the 25th to 75th percentiles. HRV indexes, including time domain, frequency domain, and sample entropy, were measured using 24-hour ambulatory electrocardiography. Clinical outcomes were defined as all-cause mortality at 2 years. During a mean follow-up of 16.5±8.2 months, there were 117 deaths (7.2%). GHF was associated with a higher risk of death (hazard ratio and 95% CIs, 1.97 [1.15-3.37]). Reduced HRV indexes, including time domain, frequency domain, and sample entropy (odds ratio and 95% CIs, 0.79 [0.70-0.89]) were all independently associated with the presence of GHF after accounting for age, sex, mean heart rate, morbidities, and medications. In subgroup analysis, reduced HRV was more predictive of GHF in the young than the elderly. Mediation analysis revealed a significant mediation effect between HRV and GHF in addition to their respective detrimental effects on survival. Conclusions Reduced HRV was independently associated with the presence of GHF. Autonomic dysfunction may be involved in the pathogenesis of adverse outcomes of GHF in individuals without prior cardiovascular events.