Hannane Nora, Mayer Christopher C, Matschkal Julia, Bormann Felix, Krieter Axel, Braun Jürgen R, Küchle Claudius, Renders Lutz, Günthner Roman, Schmidt Georg, Müller Alexander, Wassertheurer Siegfried, Heemann Uwe, Haller Bernhard, Malik Marek, Schmaderer Christoph, Braunisch Matthias Christoph
Department of Nephrology, TUM School of Medicine and Health, TUM Universitätsklinikum, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany.
Center for Health & Bioresources, Medical Signal Analysis, AIT Austrian Institute of Technology GmbH, Vienna, Austria.
J Nephrol. 2025 Jul 15. doi: 10.1007/s40620-025-02357-8.
Diabetes-driven impaired autonomic nervous system function might contribute to increased mortality in hemodialysis patients. Our study aimed to validate heart rate turbulence as a long-term predictor of mortality in this vulnerable cohort.
Heart rate turbulence is a non-invasive, 24 h electrocardiography-Holter-based assessment of cardiovascular autonomic responses. Hemodialysis patients of the "rISk strAtification in end-stage Renal disease" (ISAR) study, a prospective, multicenter observational study, were followed up for six years. Mortality hazard, and correlations between clinical characteristics and mortality, were assessed using Cox regression models.
Heart rate turbulence measurement at baseline was available in 290 hemodialysis patients, 99 (34%) with diabetes mellitus. In a multivariable analysis, abnormal heart rate turbulence was associated with a 2.1-fold (95% CI: 1.4-3.2; p < 0.001) increased risk for all-cause and 3.1-fold (95% CI: 1.5-6.2; p = 0.001) increased risk for cardiovascular mortality. The co-occurrence of abnormal heart rate turbulence and diabetes mellitus represented the strongest risk constellation, increasing all-cause mortality risk to a hazard ratio of 5.8 (95% CI: 3.3-10.4; p < 0.001) and cardiovascular mortality risk to 6.1 (95% CI: 2.5-15.1; p < 0.001). This association with mortality risk remained significant after multivariate adjustment. The interaction term between the two comorbidities indicated an approximately additive effect on mortality risk.
Heart rate turbulence significantly contributed to the prediction of long-term mortality risk in hemodialysis patients. Diabetes mellitus is a major driver of cardiovascular autonomic dysfunction, which plays a crucial role in mortality among dialysis patients. Heart rate turbulence measurement identifies high-risk patients in the dialysis setting, enhancing precision in risk prediction and stratification, and allowing an opportunity for personalized monitoring and prevention.
糖尿病导致的自主神经系统功能受损可能会导致血液透析患者死亡率增加。我们的研究旨在验证心率变异性作为这一脆弱群体死亡率的长期预测指标。
心率变异性是一种基于24小时心电图动态监测的无创性心血管自主反应评估方法。“终末期肾病风险分层”（ISAR）研究是一项前瞻性、多中心观察性研究，对其中的血液透析患者进行了为期六年的随访。使用Cox回归模型评估死亡风险以及临床特征与死亡率之间的相关性。
290例血液透析患者在基线时进行了心率变异性测量，其中99例（34%）患有糖尿病。在多变量分析中，异常心率变异性与全因死亡风险增加2.1倍（95%CI：1.4-3.2；p<0.001）以及心血管死亡风险增加3.1倍（95%CI：1.5-6.2；p=0.001）相关。异常心率变异性和糖尿病同时存在代表着最强的风险组合，全因死亡风险增加至风险比为5.8（95%CI：3.3-10.4；p<0.001），心血管死亡风险增加至6.1（95%CI：2.5-15.1；p<0.001）。多变量调整后，这种与死亡风险的关联仍然显著。两种合并症之间的交互项表明对死亡风险具有近似相加的效应。
心率变异性对血液透析患者长期死亡风险的预测有显著贡献。糖尿病是心血管自主神经功能障碍的主要驱动因素，在透析患者的死亡率中起关键作用。心率变异性测量可识别透析患者中的高危患者，提高风险预测和分层的准确性，并为个性化监测和预防提供机会。
