Τίτλος:
Heart rate variability in advanced chronic kidney disease with or without diabetes: Midterm effects of the initiation of chronic haemodialysis therapy
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Mylonopoulou, M.
Tentolouris, N.
Antonopoulos, S.
Mikros, S.
Katsaros, K.
Melidonis, A.
Sevastos, N.
Katsilambros, N.
Περιοδικό:
Nephrology Dialysis Transplantation
Λέξεις-κλειδιά:
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
