Detrended Fluctuation Analysis of Heart Rate Dynamics Is an Important Prognostic Factor in Patients with End-Stage Renal Disease Receiving Peritoneal Dialysis
Journal
PLoS ONE
Journal Volume
11
Journal Issue
2
Pages
e0147282
Date Issued
2016
Author(s)
Abstract
Background and Objectives Patients with severe kidney function impairment often have autonomic dysfunction, which could be evaluated noninvasively by heart rate variability (HRV) analysis. Nonlinear HRV parameters such as detrended fluctuation analysis (DFA) has been demonstrated to be an important outcome predictor in patients with cardiovascular diseases. Whether cardiac autonomic dysfunction measured by DFA is also a useful prognostic factor in patients with end-stage renal disease (ESRD) receiving peritoneal dialysis (PD) remains unclear. The purpose of the present study was designed to test the hypothesis. Materials and Methods Patients with ESRD receiving PD were included for the study. Twenty-four hour Holter monitor was obtained from each patient together with other important traditional prognostic makers such as underlying diseases, left ventricular ejection fraction (LVEF) and serum biochemistry profiles. Short-term (DFA?1) and long-term (DFA?2) DFA as well as other linear HRV parameters were calculated. Results A total of 132 patients (62 men, 72 women) with a mean age of 53.7±12.5 years were recruited from July 2007 to March 2009. During a median follow-up period of around 34 months, eight cardiac and six non-cardiac deaths were observed. Competing risk analysis demonstrated that decreased DFA?1 was a strong prognostic predictor for increased cardiac and total mortality. ROC analysis showed that the AUC of DFA?1 (<0.95) to predict mortality was 0.761 (95% confidence interval (CI). = 0.617.0.905). DFA?1? 0.95 was associated with lower cardiac mortality (Hazard ratio (HR) 0.062, 95% CI = 0.007.0.571, P = 0.014) and total mortality (HR = 0.109, 95% CI = 0.033.0.362, P = 0.0003). Conclusion Cardiac autonomic dysfunction evaluated by DFA?1 is an independent predictor for cardiac and total mortality in patients with ESRD receiving PD. ? 2016 Chiang et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
adult; Article; autonomic dysfunction; controlled study; detrended fluctuation analysis; end stage renal disease; female; follow up; heart left ventricle ejection fraction; heart rate variability; human; major clinical study; male; middle aged; mortality; peritoneal dialysis; prognosis; statistical analysis; heart rate; incidence; Kidney Failure, Chronic; mortality; multivariate analysis; nonlinear system; pathophysiology; peritoneal dialysis; proportional hazards model; Female; Heart Rate; Humans; Incidence; Kidney Failure, Chronic; Male; Middle Aged; Multivariate Analysis; Nonlinear Dynamics; Peritoneal Dialysis; Prognosis; Proportional Hazards Models
Publisher
Public Library of Science
Type
journal article