Key result
Daily in-center hemodialysis increases low-frequency HRV by ~50% vs conventional hemodialysis.
Why the study?
Does daily in-center hemodialysis improve heart rate variability in patients with end-stage renal disease?
RCT (n=245)
randomized
Yes
Does daily in-center hemodialysis improve heart rate variability in patients with end-stage renal disease?
Effect estimate: 50% increase (95% CI 6.1-112%)
p-value: p=0.022
Daily hemodialysis increases the low-frequency component of heart rate variability in patients with end-stage renal disease, suggesting a functional correlate to structural cardiac benefits.
Supports daily hemodialysis for autonomic benefits in ESRD; extends structural cardiac findings to functional HRV measures.
BACKGROUND: End-stage renal disease is associated with reduced heart rate variability (HRV), components of which generally are associated with advanced age, diabetes mellitus and left ventricular hypertrophy. We hypothesized that daily in-center hemodialysis (HD) would increase HRV. METHODS: The Frequent Hemodialysis Network (FHN) Daily Trial randomized 245 patients to receive 12 months of six versus three times per week in-center HD. Two hundred and seven patients had baseline Holter recordings. HRV measures were calculated from 24-h Holter electrocardiograms at both baseline and 12 months in 131 patients and included low-frequency power (LF, a measure of sympathetic modulation), high-frequency power (HF, a measure of parasympathetic modulation) and standard deviation (SD) of the R-R interval (SDNN, a measure of beat-to-beat variation). RESULTS: Baseline to Month 12 change in LF was augmented by 50% [95% confidence interval (95% CI) 6.1-112%, P =0.022] and LF + HF was augmented by 40% (95% CI 3.3-88.4%, P = 0.03) in patients assigned to daily hemodialysis (DHD) compared with conventional HD. Changes in HF and SDNN were similar between the randomized groups. The effects of DHD on LF were attenuated by advanced age and diabetes mellitus (predefined subgroups). Changes in HF (r = -0.20, P = 0.02) and SDNN (r = -0.18, P = 0.04) were inversely associated with changes in left ventricular mass (LVM). CONCLUSIONS: DHD increased the LF component of HRV. Reduction of LVM by DHD was associated with increased vagal modulation of heart rate (HF) and with increased beat-to-beat heart rate variation (SDNN), suggesting an important functional correlate to the structural effects of DHD on the heart in uremia.
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Chan et al. (2013) conducted an RCT in End-stage renal disease (n=245). Daily in-center hemodialysis vs. Conventional hemodialysis (three times per week) was evaluated on Change in low-frequency power (LF) of heart rate variability from baseline to 12 months (50% increase, 95% CI 6.1-112%, p=0.022). Daily in-center hemodialysis increased the low-frequency component of heart rate variability by 50% compared with conventional hemodialysis over 12 months (95% CI 6.1-112%; P=0.022).
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