Abstract 879: Utility of Heart Rate Variability to Identify High Risk Subset for Cardiovascular Disease Among Patient With Chronic Kidney Disease
Background: Chronic kidney disease (CKD) is well known as a risk factor for cardiovascular disease. However, relationship between those diseases is still unclear. Sympathetic nerve hyperactivity in patient with CKD was reported. Therefore, we studied heart rate variability (HRV) to understand their cardiac autonomic nerve (CAN) status, and investigated the influence of it on long-term result.
Methods: We analyzed 81 cases of 24-hour recorded electrocardiograms among CKD (≤eGFR 60ml/min/1.73m2 by MDRD) patients who felt chest discomfort. Patients with hemodialysis were excluded. HRV was assessed by SDNN (standard deviation of normal to normal RR intervals; msec), LF (low frequency; ms2) and HF (high frequency; ms2) component. We divided them into the two groups according to the value of SDNN (<100, reduced:r-SDNN or ≥100, preserved:p-SDNN), and we investigated the occurrence of major adverse cardiovascular event (MACE; cardiovascular death, non-fetal myocardial infarction, congestive heart failure, and stroke) during follow-up periods.
Results: There were 21 patients (26.0%) with r-SDNN.Decreased ln HF (3.69 vs. 4.89ms2, P=0.001) and ln LF (3.98 vs. 5.49ms2, P<0.001) component were seen in the r-SDNN group compared with p-SDNN group. The r-SDNN group had higher rate of MACE during follow-up period (P=0.001). By multivariate analysis, independent predictor of MACE is r-SDNN (Hazard ratio, 6.72; 95%CI, 1.28 –35.2; P=0.024).
Conclusion: CAN dysfunction revealed by reduced HRV was seen in 26% of CKD patients. Combination of CKD and reduced HRV associated with poor prognosis. We may be able to identify the high risk patient for cardiovascular event among patients with CKD.