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Cardiovascular Mortality Can Be Predicted by Heart Rate Turbulence in Hemodialysis Patients.

ABSTRACT: Background:Excess mortality in hemodialysis patients is mostly of cardiovascular origin. We examined the association of heart rate turbulence (HRT), a marker of baroreflex sensitivity, with cardiovascular mortality in hemodialysis patients. Methods:A population of 290 prevalent hemodialysis patients was followed up for a median of 3 years. HRT categories 0 (both turbulence onset [TO] and slope [TS] normal), 1 (TO or TS abnormal), and 2 (both TO and TS abnormal) were obtained from 24 h Holter recordings. The primary end-point was cardiovascular mortality. Associations of HRT categories with the endpoints were analyzed by multivariable Cox regression models including HRT, age, albumin, and the improved Charlson Comorbidity Index for hemodialysis patients. Multivariable linear regression analysis identified factors associated with TO and TS. Results:During the follow-up period, 20 patients died from cardiovascular causes. In patients with HRT categories 0, 1 and 2, cardiovascular mortality was 1, 10, and 22%, respectively. HRT category 2 showed the strongest independent association with cardiovascular mortality with a hazard ratio of 19.3 (95% confidence interval: 3.69-92.03; P < 0.001). Age, calcium phosphate product, and smoking status were associated with TO and TS. Diabetes mellitus and diastolic blood pressure were only associated with TS. Conclusion:Independent of known risk factors, HRT assessment allows identification of hemodialysis patients with low, intermediate, and high risk of cardiovascular mortality. Future prospective studies are needed to translate risk prediction into risk reduction in hemodialysis patients.

SUBMITTER: Braunisch MC

PROVIDER: S-EPMC7027389 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Cardiovascular Mortality Can Be Predicted by Heart Rate Turbulence in Hemodialysis Patients.

Braunisch Matthias C MC Mayer Christopher C CC Bauer Axel A Lorenz Georg G Haller Bernhard B Rizas Konstantinos D KD Hagmair Stefan S von Stülpnagel Lukas L Hamm Wolfgang W Günthner Roman R Angermann Susanne S Matschkal Julia J Kemmner Stephan S Hasenau Anna-Lena AL Zöllinger Isabel I Steubl Dominik D Mann Johannes F JF Lehnert Thomas T Scherf Julia J Braun Jürgen R JR Moog Philipp P Küchle Claudius C Renders Lutz L Malik Marek M Schmidt Georg G Wassertheurer Siegfried S Heemann Uwe U Schmaderer Christoph C

Frontiers in physiology 20200211

<h4>Background</h4>Excess mortality in hemodialysis patients is mostly of cardiovascular origin. We examined the association of heart rate turbulence (HRT), a marker of baroreflex sensitivity, with cardiovascular mortality in hemodialysis patients.<h4>Methods</h4>A population of 290 prevalent hemodialysis patients was followed up for a median of 3 years. HRT categories 0 (both turbulence onset [TO] and slope [TS] normal), 1 (TO or TS abnormal), and 2 (both TO and TS abnormal) were obtained from ...[more]

PMID: 32116784

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Project description:BackgroundObservational data have demonstrated an association between higher ultrafiltration rates and greater mortality among hemodialysis patients. Prior studies were small and did not consider potential differences in the association across body sizes and other related subgroups. No study has investigated ultrafiltration rates normalized to anthropometric measures beyond body weight. Also, potential methodological shortcomings in prior studies have led to questions about the veracity of the ultrafiltration rate-mortality association.Study designRetrospective cohort.Setting & participants118,394 hemodialysis patients dialyzing in a large dialysis organization, 2008 to 2012.PredictorsMean 30-day ultrafiltration rates were dichotomized at 13 and 10mL/h/kg, separately and categorized using various cutoff points. Ultrafiltration rates normalized to body weight, body mass index, and body surface area were investigated.OutcomesAll-cause mortality.MeasurementsMultivariable survival models were used to estimate the association between ultrafiltration rate and all-cause mortality.ResultsAt baseline, 21,735 (18.4%) individuals had ultrafiltration rates > 13mL/h/kg and 48,529 (41.0%) had ultrafiltration rates > 10mL/h/kg. Median follow-up was 2.3 years, and the mortality rate was 15.3 deaths/100 patient-years. Compared with ultrafiltration rates ≤ 13mL/h/kg, ultrafiltration rates > 13mL/h/kg were associated with greater mortality (adjusted HR, 1.31; 95% CI, 1.28-1.34). Compared with ultrafiltration rates ≤ 10mL/h/kg, ultrafiltration rates > 10mL/h/kg were associated with greater mortality (adjusted HR, 1.22; 95% CI, 1.20-1.24). Findings were consistent across subgroups of sex, race, dialysis vintage, session duration, and body size. Higher ultrafiltration rates were associated with greater mortality when normalized to body weight, body mass index, and body surface area.LimitationsResidual confounding cannot be excluded given the observational study design.ConclusionsRegardless of the threshold implemented, higher ultrafiltration rate was associated with greater mortality in the overall study population and across key subgroups. Randomized controlled trials are needed to investigate whether ultrafiltration rate reduction improves clinical outcomes.

Dataset Information

Cardiovascular Mortality Can Be Predicted by Heart Rate Turbulence in Hemodialysis Patients.

Publications

Cardiovascular Mortality Can Be Predicted by Heart Rate Turbulence in Hemodialysis Patients.

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