Huang Jiun-Chi, Kuo I-Ching, Tsai Yi-Chun, Lee Jia-Jung, Lim Lee-Moay, Chen Szu-Chia, Chiu Yi-Wen, Chang Jer-Ming, Chen Hung-Hun
Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Kidney Blood Press Res. 2017;42(1):76-88. doi: 10.1159/000469716. Epub 2017 Mar 17.
BACKGROUND/AIMS: Heart rate variability (HRV) has been linked to mortality in maintenance hemodialysis (HD) patients, but it is less clear whether HRV is associated with major adverse cardiovascular events (MACEs) and hospitalization.
This study enrolled 179 maintenance HD patients. HRV was measured to assess its prognostic significance in relation to MACEs and hospitalization.
During the follow-up period of 33.3 ± 6.7 months, 36 (20.1%) patients had a MACE, and 98 (54.7%) experienced hospitalization. In multivariate adjusted Cox regression analysis, low very low frequency (VLF) power (hazard ratio [HR], 0.727; 95% confidence interval [CI], 0.624-0.848; p < 0.001), a history of coronary artery disease, high ultrafiltration rate, the use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and the use of beta-blockers were all significantly associated with MACEs. Low VLF power (HR, 0.873; 95% CI, 0.785-0.971; p = 0.012), low serum albumin, low serum creatinine, low Kt/V levels, and high serum calcium-phosphorus product levels significantly predicted hospitalization in maintenance HD patients.
Reduced VLF power is linked to an increased risk of MACEs and hospitalization in maintenance HD patients. Assessing cardiac autonomic function through HRV is of pivotal prognostic significance for this patient population.
背景/目的：心率变异性（HRV）已被证明与维持性血液透析（HD）患者的死亡率相关，但HRV是否与主要不良心血管事件（MACE）和住院治疗有关尚不清楚。
本研究纳入了179例维持性HD患者。测量HRV以评估其与MACE和住院治疗相关的预后意义。
在33.3±6.7个月的随访期内，36例（20.1%）患者发生了MACE，98例（54.7%）经历了住院治疗。在多变量调整的Cox回归分析中，极低频率（VLF）功率降低（风险比[HR]，0.727；95%置信区间[CI]，0.624 - 0.848；p < 0.001）、冠状动脉疾病史、高超滤率、使用血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂以及使用β受体阻滞剂均与MACE显著相关。低VLF功率（HR，0.873；95%CI，0.785 - 0.971；p = 0.012）、低血清白蛋白、低血清肌酐、低Kt/V水平和高血清钙磷乘积水平显著预测了维持性HD患者的住院治疗。
VLF功率降低与维持性HD患者发生MACE和住院治疗的风险增加有关。通过HRV评估心脏自主神经功能对该患者群体具有关键的预后意义。
