Heart rate variability in diabetic and non-diabetic renal transplant patients.
BACKGROUND
Heart rate variability (HRV) has been used to investigate the autonomic modulation of heart rate. Diminished HRV has been observed in diabetic autonomic neuropathy, a condition associated with increased mortality. Uraemia is associated with impaired autonomic function, but reports on the effects of uraemia on HRV are scarce.


METHODS
HRV and its circadian variation were studied in 12 diabetic and 11 non-diabetic renal transplantation and in 12 control patients. HRV in time and frequency domains was determined from 24-hour ECG recordings.


RESULTS
In the diabetic group, all time domain and frequency domain measures of HRV were markedly reduced (P < 0.05), when compared with the control group, and the circadian variation of HRV was absent. The mean (SD) amplitudes (ms) in the frequency bands were: high frequency: 3 (1), 6 (3) and 15 (3); low frequency: 9 (7), 16 (10) and 25 (8); very low frequency: 14 (8), 23 (12) and 30 (11) in the diabetic and non-diabetic uraemic and in the control patients, respectively. In non-diabetic uraemic patients, a tendency to reduced HRV was observed, but no statistical differences in HRV measures were found when compared with the control group.


CONCLUSIONS
The severe impairment of HRV in patients with end-stage diabetic nephropathy is probably due to autonomic neuropathy and partly also to the co-existing heart diseases. It may be a contributing risk factor for ventricular arrhythmias and sudden death in these patients. Uraemia alone causes similar but less severe changes in HRV.
Kirvela
M
M
Department of Anaesthesia, Helsinki University Central Hospital, Finland.
Salmela
K
K
Toivonen
L
L
Koivusalo
A M
AM
Lindgren
L
L
D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000503:physiopathology; D002940:Circadian Rhythm; D003928:Diabetic Nephropathies / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D014511:Uremia / Q000503:physiopathology*