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Abstract: TH-PO273

Effectiveness of Heart Rate Variability for Predicting Intradialytic Hypotension in Chronic Hemodialysis Patients

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Lee, Ji won, Konyang University Hospital, Daejeon, Korea (the Republic of)
  • Yoon, Se-Hee, Konyang University Hospital, Daejeon, Korea (the Republic of)
  • Yun, Sung-Ro, Konyang University Hospital, Daejeon, Korea (the Republic of)
  • Hwang, Won Min, Konyang University Hospital, Daejeon, Korea (the Republic of)
  • Park, Yohan, Konyang University Hospital, Daejeon, Korea (the Republic of)
Background

Intradialytic hypotension(IDH) is a common complication during hemodialysis reported to occur in 20–30% of hemodialysis sessions. According to a recent meta-analysis, IDH based on nadir 90 criterion was reported to have the highest association with the patient survival rates. The heart rate variability(HRV) test is a non-invasive and simple method to measure autonomic nervous system activity. To date, no studies have demonstrated the usefulness of the HRV test in predicting IDH based on nadir 90 criterion. This study was aimed to elucidate the usefulness of the HRV test in predicting the occurrence of IDH.

Methods

This study was a multi-center prospective observational study. A total of 70 patients were enrolled in this study. Blood tests, echocardiography, and body composition measurement results were collected, and HRV test was performed for 24 hours during non-hemodialysis period. And then, a total 12 hemodialysis sessions were monitored. The patients were divided into the IDH group and non-IDH group. HRV index model was developed by a multivariate logistic regression analysis. The predictive value of IDH occurrence was analyzed through area under the receiver operating characteristic curve(AuROC) value.

Results

According to the nadir 90 criterion, 37 patients were placed in the IDH group, and 33 patients in the non-IDH group. Considering that the HRV test is affected by the lifestyle, data of night-time(00:00~04:00) was used. Standard deviation of normal-to-normal interval(SDNN), root-mean-square of successive differences(RMSSD), normal-to-normal interval>50ms(NN50) count, percentage of NN50 count(pNN50), total power(TP), very low frequency(VLF), low frequency(LF), high frequency(HF), and LF/HF ratio, which are parameters of the HRV test, were analyzed to develop a HRV index model. The AuROC value for IDH occurrence (even in one session) of the developed HRV index model was 0.776. The AuROC value for frequent IDH occurrence (in more than 10% of sessions) was 0.803. A high HRV index(>0.544) was observed as an independent risk factor after adjusting for several other confounding factors(odds ratio 6.137, P=0.011).

Conclusion

The HRV test can be used as a useful tool to predict IDH. This is the first study to demonstrate the usefulness of the HRV test in prediction of the IDH occurrence according to the nadir 90 criterion.