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March 18, 2022Journal of Nephrology

Early morning hemodynamic changes and left ventricular hypertrophy and mortality in hemodialysis patients

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Key result

A lower pre-awakening heart rate surge was associated with higher left ventricular mass index and an increased risk of death (HR 0.89 per 1 unit; 95% CI 0.83-0.96; P=0.001) in hemodialysis patients.

Why the study?

Exaggerated early morning increases in BP and HR indicate high cardiovascular risk, but early morning changes in these parameters had not been investigated in hemodialysis patients.

Are early morning hemodynamic changes associated with left ventricular hypertrophy and mortality in hemodialysis patients?

Population

58 hemodialysis patients

Comparison

Pre-awakening BP and HR surges, nocturnal dipping, and weighted 24 h systolic BP and HR variability

Design

Pilot single center study

Follow-up

Median follow up of 40 months

Authors

FMFrancesca MallamaciRTRocco TripepiCTClaudia Torino

Discussion

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Member takes

Overview

Early morning BP/HR surges in hemodialysis patients remain uncharacterized; this pilot study leaves open their prognostic value and autonomic links.

Study Design

Type

Cohort (n=58)

Multicenter

No

Structured PICO

Are early morning hemodynamic changes associated with left ventricular hypertrophy and mortality in hemodialysis patients?

P
Population
58 hemodialysis patients followed for a median of 40 months to assess the relationship between early morning hemodynamic changes and cardiovascular risk.
E
Exposure
Measurement of pre-awakening blood pressure and heart rate surges, nocturnal dipping, and weighted 24 h systolic BP and HR variability
O
Outcome
Left ventricular mass index (LVMI) and risk of death

Main Result

Hazard Ratio: 0.89 (95% CI 0.83–0.96)

p-value: p=0.001

Low early morning changes in heart rate, likely reflecting enhanced sympathetic activity, are associated with a higher risk of left ventricular hypertrophy and mortality in hemodialysis patients.

Limitations

  • Pilot study
  • Single center

Cite This Study

Mallamaci et al. (2022) conducted a cohort in Hemodialysis (n=58). Pre-awakening heart rate surge was evaluated on Left ventricular mass index (LVMI) and risk of death (HR 0.89, 95% CI 0.83-0.96, p=0.001). A lower pre-awakening heart rate surge was associated with higher left ventricular mass index and an increased risk of death (HR 0.89 per 1 unit; 95% CI 0.83-0.96; P=0.001) in hemodialysis patients.

synapsesocial.com/papers/6a9f6308cb97033d4fb20ca1https://doi.org/10.1007/s40620-022-01281-5
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Heart Rate Variability Is a Predictor of Mortality in Chronic Kidney Disease: A Report from the CRIC Study2013 · 101 citations
  2. 2Effects of blood pressure lowering on outcome incidence in hypertension2014 · 121 citations
  3. 3Cardiac Autonomic Neuropathy Predicts All-Cause and Cardiovascular Mortality in Patients With End-Stage Renal Failure: A 5-Year Prospective Study2017 · 17 citations
  4. 4The sympathetic/parasympathetic imbalance in heart failure with reduced ejection fraction2015 · 256 citations
  5. 5Sympathetic Overactivity in Patients with Chronic Renal Failure1992 · 1,144 citations