Key result
Patients with stage 5 chronic kidney disease on maintenance haemodialysis had a significantly lower mean late heart-to-mediastinum ratio compared to healthy controls (2.3 vs 2.9), which did not worsen during the first 6 months of dialysis.
Why the study?
Does the commencement of maintenance haemodialysis alter cardiac sympathetic innervation in patients with stage 5 chronic kidney disease?
Observational (n=27)
No
Does the commencement of maintenance haemodialysis alter cardiac sympathetic innervation in patients with stage 5 chronic kidney disease?
Mean Difference: -0.6 (95% CI -1.1–-0.46)
Absolute Event Rate: 2.3% vs 2.9%
p-value: p=0.035
Cardiac sympathetic innervation abnormalities are present in stage 5 CKD patients but do not appear to progress significantly during the first 6 months of maintenance haemodialysis.
Sympathetic denervation evident at dialysis start but stable at 6 months; leaves open longer-term progression and intervention targets in stage 5 CKD.
Patients with chronic kidney disease (CKD) who undergo chronic haemodialysis (HD) show altered sympathetic tone, which is related to a higher cardiovascular mortality. The purpose of this study was to investigate the effect of transition from pre-HD to HD on cardiac sympathetic innervation. Eighteen patients aged 58 ± 18 years (mean ± standard deviation [SD]), 13 males and five females, with stage 5 CKD and nine healthy control subjects aged 52 ± 17 (mean ± SD), three males and six females, were included in this prospective study between May 2010 and December 2013. All patients underwent 123 I-labelled meta-iodobenzylguanidine ( 123 I-MIBG) scintigraphy for cardiac sympathetic innervation and electrocardiographically gated adenosine stress and rest 99m Tc-labelled tetrofosmin single-photon emission computed tomography for myocardial perfusion imaging prior to (pre-HD) and 6 months after the start of HD. Results of 123 I-MIBG scans in patients were compared to controls. Impaired cardiac sympathetic innervation was defined as late heart-to-mediastinum ratio (HMR) < 2.0. Mean late HMR was lower in patients during HD (2.3) than in controls (2.9) ( p = 0.035); however, in patients it did not differ between pre-HD and after the start of HD. During HD, two patients showed new sympathetic innervation abnormalities, and in three patients innervation abnormalities seemed to coincide with myocardial perfusion abnormalities. CKD patients show cardiac sympathetic innervation abnormalities, which do not seem to progress during the maintenance HD. The relationship between sympathetic innervation abnormalities and myocardial perfusion abnormalities in HD patients needs further exploration.
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Noordzij et al. (2017) conducted an observational in Stage 5 Chronic Kidney Disease (n=27). Maintenance haemodialysis vs. Healthy controls was evaluated on Late heart-to-mediastinum ratio (HMR) (difference -0.6, 95% CI -1.1 to -0.46, p=0.035). Patients with stage 5 chronic kidney disease on maintenance haemodialysis had a significantly lower mean late heart-to-mediastinum ratio compared to healthy controls (2.3 vs 2.9), which did not worsen during the first 6 months of dialysis.
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