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Clinical significance of heart rate variability for the monitoring of cardiac autonomic neuropathy in end-stage renal disease patients

Authors:	Ji Won Min Ji-Yeun Chang Hanbi Lee Yohan Park Eun Jeong Ko Jae Hyoung Cho Chul Woo Yang Byung Ha Chung

Institution:	1. Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea;2. Division of Nephrology, Department of Internal Medicine, Seoul St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea;3. Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

Abstract:	Background and aimsThe aim of this study is to determine whether the measurement of continuous heart rate variability (HRV) is useful in the evaluation of cardiac autonomic neuropathy (CAN) in end-stage renal disease (ESRD) patients.Methods and resultsThis cross-sectional study was performed at Seoul St. Mary's hospital between June 2017 and February 2018. Seventy-seven ESRD patients, and 29 healthy controls (HCs) were asked to wear a continuous ambulatory HRV monitor for 24 h. General cardiac function was evaluated using transthoracic echocardiogram (TTE), pulse wave velocity (PWV), coronary calcium scoring (CCS), and 24-h ambulatory blood pressure monitoring (ABPM). HRV parameters of ESRD patients and HCs, and the correlation of HRV parameters with cardiovascular screening methods were observed. All HRV parameters were significantly decreased in ESRD patients compared to HCs (P < 0.001). In the correlation analysis between TTE results and HRV parameters, 24-h standard deviation of all N–N intervals (24SDNN), 24-h standard deviation of sequential 5-min N–N interval means (24DANN) and Low Frequency Power/High Frequency Power (LF/HF) ratio showed negative correlations with E/e’, LAVI and TR velocity which are representative indices for the diastolic function of the heart (P < 0.05). HRV parameters showed negative correlations with baPWV, CCS, and 24-h ABPM results as well (P < 0.05). Hemoglobin and serum albumin showed positive correlations with HRV parameters, and glucose, BUN, creatinine, and iPTH levels showed negative correlations (P < 0.05).ConclusionContinuous HRV monitoring may be a useful tool for the evaluation of CAN in ESRD.

Keywords:	Heart rate variability End stage renal disease Cardiac autonomic neuropathy Diastolic dysfunction 24SDANN"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"24-h standard deviation of sequential 5-min N–N interval means 24SDNN"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"24-h standard deviation of all N–N intervals ABPM"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"ambulatory blood pressure monitoring baPWV"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"brachial-ankle pulse wave velocity BUN"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"blood urea nitrogen CAN"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"cardiac autonomic neuropathy CCS"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"coronary calcium scoring CKD"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"chronic kidney disease DBP"} {"#name":"keyword" "$":{"id":"kwrd0115"} "$$":[{"#name":"text" "_":"diastolic blood pressure DM"} {"#name":"keyword" "$":{"id":"kwrd0125"} "$$":[{"#name":"text" "_":"diabetes mellitus E"} {"#name":"keyword" "$":{"id":"kwrd0135"} "$$":[{"#name":"text" "_":"early diastolic transmitral flow velocity E/A"} {"#name":"keyword" "$":{"id":"kwrd0145"} "$$":[{"#name":"text" "_":"early to late diastolic transmitral flow velocity E/e’"} {"#name":"keyword" "$":{"id":"kwrd0155"} "$$":[{"#name":"text" "_":"E to early diastolic mitral annular tissue velocity ESRD"} {"#name":"keyword" "$":{"id":"kwrd0165"} "$$":[{"#name":"text" "_":"end-stage renal disease HCs"} {"#name":"keyword" "$":{"id":"kwrd0175"} "$$":[{"#name":"text" "_":"healthy controls HF"} {"#name":"keyword" "$":{"id":"kwrd0185"} "$$":[{"#name":"text" "_":"high frequency HRCT"} {"#name":"keyword" "$":{"id":"kwrd0195"} "$$":[{"#name":"text" "_":"high resolution computed tomography HRV"} {"#name":"keyword" "$":{"id":"kwrd0205"} "$$":[{"#name":"text" "_":"heart rate variability iPTH"} {"#name":"keyword" "$":{"id":"kwrd0215"} "$$":[{"#name":"text" "_":"intact-parathyroid hormone LAVI"} {"#name":"keyword" "$":{"id":"kwrd0225"} "$$":[{"#name":"text" "_":"left atrial volume indexed to body surface area LF"} {"#name":"keyword" "$":{"id":"kwrd0235"} "$$":[{"#name":"text" "_":"low frequency LVDD"} {"#name":"keyword" "$":{"id":"kwrd0245"} "$$":[{"#name":"text" "_":"left ventricular diastolic dysfunction LVEF"} {"#name":"keyword" "$":{"id":"kwrd0255"} "$$":[{"#name":"text" "_":"left ventricular ejection fraction MIBG"} {"#name":"keyword" "$":{"id":"kwrd0265"} "$$":[{"#name":"text" "_":"metaiodobenzylguanidine RAAS"} {"#name":"keyword" "$":{"id":"kwrd0275"} "$$":[{"#name":"text" "_":"renin-angiotensin-aldosterone RMSSD"} {"#name":"keyword" "$":{"id":"kwrd0285"} "$$":[{"#name":"text" "_":"root mean square of successive differences between N–N intervals SBP"} {"#name":"keyword" "$":{"id":"kwrd0295"} "$$":[{"#name":"text" "_":"systolic blood pressure TP"} {"#name":"keyword" "$":{"id":"kwrd0305"} "$$":[{"#name":"text" "_":"total power TR"} {"#name":"keyword" "$":{"id":"kwrd0315"} "$$":[{"#name":"text" "_":"tricuspid regurgitation TTE"} {"#name":"keyword" "$":{"id":"kwrd0325"} "$$":[{"#name":"text" "_":"transthoracic echocardiogram
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