Moloney Bróna M, Chertow Glenn M, Mc Causland Finnian R
Brigham and Women's Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
Kidney360. 2025 Mar 13;6(7):1127-1134. doi: 10.34067/KID.0000000765.
Patients with diabetes on hemodialysis had 18% lower SD of the normal-to-normal R-R interval, a proxy for lower heart rate variability. The association of diabetes with intradialytic hypotension was not mediated by SD of the normal-to-normal R-R interval. Targeted therapies to mitigate autonomic neuropathy in patients with diabetes on hemodialysis warrant further investigation.
Autonomic dysfunction is common among patients with diabetes receiving hemodialysis. We wished to explore the association of diabetes with heart rate variability (HRV; a surrogate of autonomic dysfunction) and whether HRV mediates the association of diabetes with intradialytic hypotension (IDH).
In this secondary analysis of the Frequent Hemodialysis Network Daily Trial, we performed the following: () random effects linear regression to estimate the association of diabetes with log-transformed low-frequency (LF) power (proxy of sympathetic activity), high-frequency (HF) power (proxy of parasympathetic activity), ratio of LF/HF (proxy for sympathovagal balance), and SD of the normal-to-normal R-R interval (SDNN, measured at baseline and 12 months) and () linear regression to explore the association of diabetes with changes in HRV parameters over 12 months. Models were adjusted for age, sex, designated race, height, access type, hemodialysis vintage, history of heart failure, prehemodialysis systolic BP, heart rate, ultrafiltration rate, hemoglobin, serum albumin, -blocker use, calcium channel blocker use, diuretic use, left ventricular mass, and randomized treatment assignment.
Of the 198 patients without baseline atrial fibrillation, 82 (41%) had self-reported diabetes. In adjusted random effects models, diabetes (versus no diabetes) was associated with lower SDNN −18% (95% confidence interval [CI], −27 to −9) on a per session basis. The presence of diabetes was not associated with differences in LF 7% (95% CI, −20 to 43), HF 10% (95% CI, −10 to 33), or LF/HF −4% (95% CI, −19 to 14). Diabetes (versus no diabetes) was not associated with a change from baseline to 12 months in any HRV parameter. SDNN did not attenuate the observed association of diabetes with IDH.
Among participants in the Frequent Hemodialysis Network Daily Trial, diabetes (versus no diabetes) was associated with 18% lower SDNN. The association of diabetes with IDH did not seem to be mediated by SDNN. The reasons for higher rates of IDH in patients with diabetes remain elusive.
: NCT00264758.
接受血液透析的糖尿病患者正常到正常R-R间期的标准差降低了18%，这是心率变异性降低的一个指标。糖尿病与透析中低血压的关联并非由正常到正常R-R间期的标准差介导。针对接受血液透析的糖尿病患者自主神经病变的靶向治疗值得进一步研究。
自主神经功能障碍在接受血液透析的糖尿病患者中很常见。我们希望探讨糖尿病与心率变异性（HRV；自主神经功能障碍的一个替代指标）之间的关联，以及HRV是否介导糖尿病与透析中低血压（IDH）之间的关联。
在对频繁血液透析网络每日试验的这项二次分析中，我们进行了以下操作：（1）随机效应线性回归，以估计糖尿病与对数转换后的低频（LF）功率（交感神经活动的替代指标）、高频（HF）功率（副交感神经活动的替代指标）、LF/HF比值（交感迷走神经平衡的替代指标）以及正常到正常R-R间期的标准差（SDNN，在基线和12个月时测量）之间的关联；（2）线性回归，以探讨糖尿病与12个月内HRV参数变化之间的关联。模型对年龄、性别、指定种族、身高、血管通路类型、血液透析年限、心力衰竭病史、透析前收缩压、心率、超滤率、血红蛋白、血清白蛋白、使用β受体阻滞剂、使用钙通道阻滞剂、使用利尿剂、左心室质量和随机治疗分配进行了调整。
在198例无基线房颤的患者中，82例（41%）自述患有糖尿病。在调整后的随机效应模型中，糖尿病（与无糖尿病相比）与每次透析时较低的SDNN相关，降低了18%（95%置信区间[CI]，-27至-9）。糖尿病的存在与LF（7%，95%CI，-20至43）、HF（10%，95%CI，-10至33）或LF/HF（-4%，95%CI，-19至14）的差异无关。糖尿病（与无糖尿病相比）与从基线到12个月的任何HRV参数变化均无关。SDNN并未减弱观察到的糖尿病与IDH之间的关联。
在频繁血液透析网络每日试验的参与者中，糖尿病（与无糖尿病相比）与SDNN降低18%相关。糖尿病与IDH之间的关联似乎并非由SDNN介导。糖尿病患者IDH发生率较高的原因仍不清楚。
NCT00264758。
