Kidney Week

Abstract: TH-PO203

Assessing Heart Rate Variability in Patients with CKD: Association with Vascular Dysfunction

Session Information

• Hypertension and CVD: Clinical - I
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Nyarko, Obed Ofori, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, United States

Obed Ofori Nyarko,

• Steele, Cortney, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, United States

Cortney Steele,

• Oh, Ester, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, United States

Ester Oh,

• Farmer-Bailey, Heather, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, United States

Heather Farmer-Bailey,

• Britz, Mallory, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, United States

Mallory Britz,

• Chonchol, Michel, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, United States

Michel Chonchol,

• Nowak, Kristen L., University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, United States

Kristen L. Nowak,

Background

Autonomic dysfunction (AD) has been recognized as an important contributor to poor outcomes in patients with chronic kidney disease (CKD) characterized by adrenergic overdrive and/or loss of parasympathetic activity. Heart rate variability (HRV) is a measure of the exact changes between successive R-R intervals in a heartbeat and reflects the balance between sympathetic and parasympathetic tone. HRV has been associated with all-cause mortality and vascular dysfunction in patients with cardiovascular diseases, but very few studies have assessed its association with vascular disease and dysfunction in CKD. Thus, this study examined HRV in patients with CKD and how it associates with vascular dysfunction.

Methods

This study cross-sectionally pooled baseline data from three clinical studies conducted in patients with stage 3-4 CKD. Five-minute electrocardiogram readings at rest with paced breathing were analyzed using an automated HRV analysis tool in the LabChart software. HRV parameters were compared to age-matched healthy controls. Regression models were used to evaluate associations of low HRV with other vascular parameters: endothelial dysfunction (brachial artery flow-mediated dilation [FMD_B%]), central arterial stiffness (carotid-femoral pulse-wave velocity [CFPWV]), local arterial compliance (carotid artery compliance), cerebrovascular stiffness (resting middle cerebral artery pulsatility index), and cerebrovascular reactivity (middle cerebral artery blood flow-velocity response to hypercapnia) in the CKD group.

Results

Forty-four participants with CKD (33/11 M/F; mean age (years) ± s.d 68±7, eGFR 44±11 ml/min/1.73m²) were compared to nine age-matched controls (4/5 M/F; 65±8 years, eGFR 97±18 ml/min/1.73m²). Patients with CKD had lower HRV (pRR50; Percent of adjacent R-R intervals with a difference greater than 50 ms) compared to controls (CKD: 7.7±4.2; control: 25.0±16.5; P=0.0001). Low pRR50 was inversely associated with endothelial dysfunction (FMD_B%) (r = -0.4320, P<0.05), but not with other vascular parameters.

Conclusion

Patients with CKD had lower HRV (autonomic dysfunction) than age-matched healthy controls. Low HRV associates with endothelial dysfunction. This observation should be explored in a larger cohort with further covariate adjustment.

Funding

• NIDDK Support