Braunisch Matthias C, Mayer Christopher C, Bauer Axel, Lorenz Georg, Haller Bernhard, Rizas Konstantinos D, Hagmair Stefan, von Stülpnagel Lukas, Hamm Wolfgang, Günthner Roman, Angermann Susanne, Matschkal Julia, Kemmner Stephan, Hasenau Anna-Lena, Zöllinger Isabel, Steubl Dominik, Mann Johannes F, Lehnert Thomas, Scherf Julia, Braun Jürgen R, Moog Philipp, Küchle Claudius, Renders Lutz, Malik Marek, Schmidt Georg, Wassertheurer Siegfried, Heemann Uwe, Schmaderer Christoph
Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany.
Center for Health & Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria.
Front Physiol. 2020 Feb 11;11:77. doi: 10.3389/fphys.2020.00077. eCollection 2020.
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.
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.
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; < 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.
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.
血液透析患者的过高死亡率大多源于心血管疾病。我们研究了压力反射敏感性标志物心率震荡（HRT）与血液透析患者心血管死亡率之间的关联。
对290例维持性血液透析患者进行了为期3年的随访。通过24小时动态心电图记录获得HRT分类0（震荡起始[TO]和斜率[TS]均正常）、1（TO或TS异常）和2（TO和TS均异常）。主要终点是心血管死亡率。采用多变量Cox回归模型分析HRT分类与终点之间的关联，该模型包括HRT、年龄、白蛋白以及血液透析患者改良的Charlson合并症指数。多变量线性回归分析确定了与TO和TS相关的因素。
随访期间，20例患者死于心血管原因。在HRT分类为0、1和2的患者中，心血管死亡率分别为1%、10%和22%。HRT分类2与心血管死亡率的独立关联最强，风险比为19.3（95%置信区间：3.69 - 92.03；P < 0.001）。年龄、钙磷乘积和吸烟状况与TO和TS相关。糖尿病和舒张压仅与TS相关。
独立于已知危险因素，HRT评估可识别出血液透析患者心血管死亡低、中、高风险人群。未来需要进行前瞻性研究，以便将风险预测转化为降低血液透析患者的风险。
