Key result
Higher post-dialysis very low frequency (VLF) heart rate variability was independently associated with a lower risk of all-cause mortality (HR 0.881) in patients with end-stage kidney disease.
Why the study?
Autonomic disturbance is common in end-stage kidney disease, but the predictive value of heart rate variability on all-cause mortality and the proper timing of assessment remained to be evaluated.
Does heart rate variability predict all-cause mortality in patients with end-stage kidney disease on hemodialysis?
Cohort (n=163)
No
Does heart rate variability predict all-cause mortality in patients with end-stage kidney disease on hemodialysis?
Hazard Ratio: 0.881 (95% CI 0.828–0.937)
p-value: p=<0.001
Post-dialysis heart rate variability, particularly very low frequency (VLF), is an independent predictor of all-cause mortality in patients with end-stage kidney disease on hemodialysis.
Post-dialysis HRV parameters were associated with mortality in ESKD; leaves open whether timing-specific assessment improves risk stratification in prospective studies.
Autonomic disturbance is common in end-stage kidney disease (ESKD). Heart rate variability (HRV) is a useful tool to assess autonomic function. We aimed to evaluate the predictive value of HRV on all-cause mortality and explore the proper timing of HRV assessment. This prospective cohort study enrolled 163 ESKD on hemodialysis patients from April-December 2018. HRV measurements were recorded ten minutes before hemodialysis, four hours during hemodialysis, and ten minutes after hemodialysis. Clinical parameters and all-cause mortality were recorded. Cox-proportional hazard regression was used for statistical analysis. After a median follow up of 40 months, 37 (22.7%) patients died. Post-dialysis HRV parameters including higher very low frequency (VLF) (hazard ratio [HR], 0.881; 95%confidence interval [CI], 0.828-0.937; p<0.001), higher normalized low frequency (nLF) (HR, 0.950; 95%CI, 0.917-0.984; p = 0.005) and higher LF/HF ratio (HR, 0.232; 95%CI, 0.087-0.619; p = 0.004) were the independent predictors associated with lower risk for all-cause mortality. Higher post-dialysis normalized high frequency (nHF) increased risk of mortality (HR, 1.051; 95%CI, 1.015-1.089; p = 0.005). HRV parameters at pre-dialysis and during dialysis were not predictive for all-cause mortality. The area under receiver operating characteristic curve (AuROC) of VLF for survival was highest compared to other HRV parameters at post-dialysis period (AuROC 0.71; 95% CI; 0.62-0.79; p<0.001). In conclusion, post-dialysis HRV parameters predicted all-cause mortaliy in ESKD. VLF measured at post-dialysis exhibited best predictive value for survival in chronic hemodialysis patients.
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Osataphan et al. (2023) conducted a cohort in End-stage kidney disease on hemodialysis (n=163). Post-dialysis heart rate variability (VLF) vs. Lower HRV was evaluated on All-cause mortality (HR 0.881, 95% CI 0.828-0.937, p=<0.001). Higher post-dialysis very low frequency (VLF) heart rate variability was independently associated with a lower risk of all-cause mortality (HR 0.881) in patients with end-stage kidney disease.
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