@article{3111890,
    title = "Heart rate variability in advanced chronic kidney disease with or without diabetes: Midterm effects of the initiation of chronic haemodialysis therapy",
    author = "Mylonopoulou, M. and Tentolouris, N. and Antonopoulos, S. and Mikros, S. and Katsaros, K. and Melidonis, A. and Sevastos, N. and Katsilambros, N.",
    journal = "Nephrology Dialysis Transplantation",
    year = "2010",
    volume = "25",
    number = "11",
    pages = "3749-3754",
    issn = "0931-0509, 1460-2385",
    doi = "10.1093/ndt/gfq226",
    keywords = "aged;  article;  autonomic nervous system function;  chronic kidney disease;  controlled study;  female;  frequency analysis;  heart rate variability;  hemodialysis;  Holter monitoring;  human;  long term care;  major clinical study;  male;  non insulin dependent diabetes mellitus;  priority journal;  sympathetic function;  time;  treatment duration;  adult;  chronic kidney failure;  diabetic nephropathy;  heart rate;  middle aged;  pathophysiology;  renal replacement therapy, Adult;  Aged;  Diabetes Mellitus, Type 2;  Diabetic Nephropathies;  Female;  Heart Rate;  Humans;  Kidney Failure, Chronic;  Male;  Middle Aged;  Renal Dialysis",
    abstract = "Background. Previous studies in different clinical settings have established heart rate variability (HRV) as a significant independent risk factor for higher mortality and cardiac death. The aim of this study was to examine the effect of chronic haemodialysis therapy on time- and frequencydomain parameters of HRV in diabetic and non-diabetic patients with chronic kidney disease (CKD). Methods. We studied 25 patients with stage 4 CKD and type 2 diabetes mellitus (CKD4+DM), 25 patients with stage 4 CKD without diabetes (CKD4), 25 patients with type 2 diabetes mellitus (DM) and 25 healthy subjects (HS). The study was performed in two phases. In the first phase, a 24-h Holter electrocardiographic (ECG) monitoring was performed in all subjects. The patients with stage 4 CKD were followed up until they progressed to stage 5, and in the second phase of the study, they underwent a 24-h Holter ECG monitoring after completion of 3months of conventional haemodialysis treatment. Results. In the first phase of the study, a reduction in cardiac sympathetic activity in CKD4 patients (significantly lower SDNN, SDANN/5 min, SD and VLF vs. HS) and worse autonomic function in CKD4+DMpatients (significantly lower SDNN, SDANN/5 min, SD, VLFand LF/HF) vs. HS,DM and CKD4 was observed. After 3 months of dialysis therapy, the patients with CKD+DM showed a significant improvement only in the time-domain parameter SDANN/5 min, while the time-domain parameters SDNN, SDANN/5 min and SD were improved in CKD patients without diabetes. Frequency-domain parameters of HRV remained unchanged in both groups. Conclusions. CKD is associated with worse cardiac autonomic function. Haemodialysis therapy for 3 months improves some indices of HRV, and this effect is more pronounced in non-diabetic subjects. Our findings suggest that the improvement of HRVafter the initiation of chronic dialysis therapy can ameliorate clinical outcomes and survival in patients with end-stage renal disease. © The Author 2010."
}