Evaluation of role of heart rate variability with holter monitoring in chronic kidney disease

Naveen Reddy Avula, Tushar Dighe, Atul Sajgure, Charan Bale, Pavan Wakhare


Background: Chronic kidney disease is prevalent disease even in absence of diabetes and hypertension in 12% adults over 65 yrs of age. Autonomic imbalance is not studied in detail which could be a risk factor for chronic kidney disease.

Methods: This Study was observational study in a tertiary care Hospital in pune, india and was conducted for a period of 1 year with sample size of 52. All subjects were known cases of chronic kidney disease from stage III to VD. All individuals of age >18yrs and eGFR ≤60ml/min/1.73m2 according to CKD- EPI equation were included in the study and who were not giving consent were excluded. 24 hrs Holter monitoring was done in stages from ckd stages III to V, for ckd stage VD on both Hemodialysis day and Non hemodialysis. Analysis was done using SPSS version 20 (IBM SPSS Statistics Inc., Chicago, Illinois, USA) Windows software program. The paired t test, analysis of variance (ANOVA) and Chi-square test were used. Level of significance was set at p≤0.05.

Results: In this study when Heart rate variability (HRV) parameters were compared in different stages of ckd from stage III to VD (on Hemodialysis day) SDNN, SDNN Index were found to be statistically significant and on non Hemodialysis day SDNN Index was found to be statistically significant. In each subgroup of ckd stage V when diabetic subjects were compared with non-diabetic subjects, HRV parameters like ratio of P/S which was found to be low and significant in ckd stage V diabetic subjects.

Conclusions: Chronic kidney disease itself can affect the HRV parameters. Causal relationship between HRV and chronic kidney diseases can be vice versa and further needs larger and prospective studies.


Chronic kidney disease, Heart rate variability, Hemodialysis

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Coresh J, Byrd-Holt D, Astor BC, Briggs JP, Eggers PW, Lacher DA, et al. Chronic kidney disease awareness, prevalence, and trends among US adults, 1999 to 2000. J Am Soc Nephrol. 2005 Jan 1;16(1):180-8.

DiBona GF. Physiology in perspective: The Wisdom of the Body. Neural control of the kidney. Am J Physiol Regul, Integrat Comparat Physiol. 2005 Sep;289(3):R633-41.

Dibona GF. Neural control of the kidney: past, present, and future. Hypertension. 2003 Mar 1;41(3):621-4.

Koomans HA, Blankestijn PJ, Joles JA. Sympathetic hyperactivity in chronic renal failure: a wake-up call. J Am Soc Nephrol. 2004 Mar 1;15(3):524-37.

Kudaiberdieva G, Görenek B, Timuralp B. Heart rate variability as a predictor of sudden cardiac death. Anatolian J Cardiol. 2007 Jul 2;7.

Carney RM, Blumenthal JA, Freedland KE, Stein PK, Howells WB, Berkman LF, et al. Low heart rate variability and the effect of depression on post-myocardial infarction mortality. Arch Internal Medi. 2005 Jul 11;165(13):1486-91.

Bilchick KC, Fetics B, Djoukeng R, Fisher SG, Fletcher RD, Singh SN, et al. Prognostic value of heart rate variability in chronic congestive heart failure (Veterans Affairs’ Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure). Am J Cardiol. 2002 Jul 1;90(1):24-8.

Schroeder EB, Chambless LE, Liao D, Prineas RJ, Evans GW, Rosamond WD, et al. Diabetes, glucose, insulin, and heart rate variability: the Atherosclerosis Risk in Communities (ARIC) study. Diabet Care. 2005 Mar 1;28(3):668-74.

Levey AS, Coresh J, Bolton K, Culleton B, Harvey KS, Ikizler TA, et al. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002 Mar 9;39(2 SUPPL. 1).

James MT, Hemmelgarn BR, Tonelli M. Early recognition and prevention of chronic kidney disease. Lancet. 2010 Apr 10;375(9722):1296-309.

Gillett MJ. International expert committee report on the role of the A1c assay in the diagnosis of diabetes. Diabet Care 2009; 32 (7): 1327-34.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Internal Medi. 2009 May 5;150(9):604-12.

Alderman MH, Cohen H, Roqué R, Madhavan S. Effect of long-acting and short-acting calcium antagonists on cardiovascular outcomes in hypertensive patients. Lancet. 1997 Mar 1;349(9052):594-8.

Furberg CD, Psaty BM, Meyer JV. Nifedipine: dose-related increase in mortality in patients with coronary heart disease. Circulation. 1995 Sep 1;92(5):1326-31.

Psaty BM, Heckbert SR, Koepsell TD, Siscovick DS, Raghunathan TE, Weiss NS, et al. The risk of myocardial infarction associated with antihypertensive drug therapies. JAMA. 1995 Aug 23;274(8):620-5.

Eguchi K, Kario K, Shimada K. Differential effects of a long-acting angiotensin converting enzyme inhibitor (temocapril) and a long-acting calcium antagonist (amlodipine) on ventricular ectopic beats in older hypertensive patients. Hypertens Res. 2002;25(3):329-33.

Grassi G, Spaziani D, Seravalle G, Bertinieri G, Dell’Oro R, Cuspidi C, et al. Effects of amlodipine on sympathetic nerve traffic and baroreflex control of circulation in heart failure. Hypertension. 1999 Feb;33(2):671-5.

Hamada T, Watanabe M, Kaneda T, Ohtahara A, Kinugawa T, Hisatome I, et al. Evaluation of changes in sympathetic nerve activity and heart rate in essential hypertensive patients induced by amlodipine and nifedipine. J Hypertens. 1998 Jan 1;16(1):111-8.

Longenecker JC, Zubaid M, Johny KV, Attia AI, Ali J, Rashed W, et al. Association of low heart rate variability with atherosclerotic cardiovascular disease in hemodialysis patients. Medi Princi Pract. 2009;18(2):85-92.

Oikawa K, Ishihara R, Maeda T, Yamaguchi K, Koike A, Kawaguchi H, et al. Prognostic value of heart rate variability in patients with renal failure on hemodialysis. Int J Cardiol. 2009 Jan 24;131(3):370-7.

Ferrario M, Moissl U, Garzotto F, Cruz DN, Tetta C, Signorini MG, et al. The forgotten role of central volume in low frequency oscillations of heart rate variability. PloS One. 2015;10(3).

Genovesi S, Bracchi O, Fabbrini P, Luisetto E, Vigano MR, Lucini D, et al. Differences in heart rate variability during haemodialysis and haemofiltration. Nephrol Dialys Transplantat. 2007 Aug 1;22(8):2256-62.

Barnas MG, Boer WH, Koomans HA. Hemodynamic patterns and spectral analysis of heart rate variability during dialysis hypotension. J Am Soc Nephrol. 1999 Dec 1;10(12):2577-84.

Hathaway DK, Cashion AK, Milstead EJ, Winsett RP, Cowan PA, Wicks MN, et al. Autonomic dysregulation in patients awaiting kidney transplantation. Am J Kidney Dis. 1998 Aug 1;32(2):221-9.

Bavanandan S, Ajayi S, Fentum B, Paul SK, Carr SJ, Robinson TG. Cardiac baroreceptor sensitivity: A prognostic marker in predialysis chronic kidney disease patients?. Kidney Int. 2005 Mar 1;67(3):1019-27.

Vita G, Bellinghieri G, Trusso A, Costantino G, Santoro D, Monteleone F, et al. Uremic autonomic neuropathy studied by spectral analysis of heart rate. Kidney Int. 1999 Jul 1;56(1):232-7.

Ewing DJ, Martyn CN, Young RJ, Clarke BF. The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabet Care. 1985 Sep 1;8(5):491-8.

Ewing DJ, Winney R. Autonomic function in patients with chronic renal failure on intermittent haemodialysis. Nephron. 1975;15(6):424-9.

Weise F, London GM, Pannier BM, Guerin AP, Elghozi JL. Effect of hemodialysis on cardiovascular rhythms in end-stage renal failure. Kidney Int. 1995 May 1;47(5):1443-52.

Algra A, Tijssen JG, Roelandt JR, Pool J, Lubsen J. Heart rate variability from 24-hour electrocardiography and the 2-year risk for sudden death. Circulation. 1993 Jul;88(1):180-5.

Kleiger RE, Miller JP, Bigger Jr JT, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987 Feb 1;59(4):256-62.

Campese VM, Romoff MS, Levitan D, Lane K, Massry SG. Mechanisms of autonomic nervous system dysfunction in uremia. Kidney Int. 1981 Aug 1;20(2):246-53.

Heidbreder E, Schafferhans K, Heidland A. Autonomic neuropathy in chronic renal insufficiency. Nephron. 1985;41(1):50-6.