What is the clinical evidence from this study?

Study design: Cohort. Population: Healthy adults (general population) (n=13241). Intervention: Highest resting heart rate quartile (lowest heart rate variability) vs. Lower resting heart rate quartiles (higher heart rate variability). Primary outcome: Incident ESRD (HR 1.98, 95% CI 1.45-2.70).

July 8, 2010Open Access

Heart Rate Variability Predicts ESRD and CKD-Related Hospitalization

Key Result

Higher resting heart rate and lower heart rate variability were significantly associated with an increased risk of incident ESRD (HR 1.98) over a median 16-year follow-up.

Study Design

Type

Cohort (n=13,241)

Multicenter

Yes

Structured PICO

Do higher resting heart rate and lower heart rate variability predict incident ESRD and CKD-related hospitalizations in adults?

Population

13,241 adults (45- to 64-years old) in the Atherosclerosis Risk in Communities (ARIC) Study

Intervention

Higher resting heart rate (highest quartile) and lower heart rate variability (lowest quartile by time and frequency domain measures)

Comparator

Lower resting heart rate and higher heart rate variability (other quartiles)

Outcome

Incident end-stage renal disease (ESRD) and chronic kidney disease (CKD)-related hospitalizationshard clinical

Autonomic dysfunction, indicated by higher resting heart rate and lower heart rate variability, is a significant long-term risk factor for incident ESRD and CKD-related hospitalizations.

Main Result

Effect estimate: HR 1.98 (95% CI 1.45-2.70)

Limitations

Baseline urinary albumin excretion was not measured, making it difficult to exclude reverse causality.
Lacked serum creatinine measurements during the 3-year follow-up visits, impairing the ability to assess CKD progression.
About 2000 patients enrolled in ARIC did not have baseline HRV measurements.
HRV measurements were limited by the absence of postural stimulation and longer recording intervals.
Hospitalizations occurring outside the study area or in non-acute care institutions might be missed.
Potential for residual confounding despite adjustment for cardiovascular risk factors.

Abstract

Autonomic imbalance, a feature of both diabetes and hypertension, may contribute to adverse cardiovascular outcomes. In animal models, sympathetic nerve activity contributes to renal damage but the extent to which autonomic dysfunction precedes the development of CKD and ESRD in humans is unknown. We measured resting heart rate and heart rate variability in 13,241 adults (45- to 64-years old) followed for a median of 16 years in the Atherosclerosis Risk in Communities (ARIC) Study. We examined heart rate parameters by quartiles, defining those in the lowest quartile (by time and frequency domain measures separately) as the risk group of interest. We identified 199 cases of incident ESRD and 541 patients with CKD-related hospitalizations; higher resting heart rate and lower heart rate variability associated with both outcomes. The fully adjusted hazard ratios for ESRD were 1.98 (95% confidence interval CI 1.45 to 2.70) among those in the highest heart rate quartile and 1.56 (95% CI 1.14 to 2.14) for high-frequency power. Other time and frequency domain measures were similarly and significantly associated with ESRD and CKD-related hospitalizations. These results suggest that autonomic dysfunction may be an important risk factor for ESRD and CKD-related hospitalizations and call for further studies to define the mechanisms that underlie these associations.

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