title: Prognostic value of heart rate variability in patients with renal failure on hemodialysis.
abstract: BACKGROUND
  In patients with renal failure on hemodialysis cardiovascular disease is a major cause of death. It has been reported that diminished heart rate variability (HRV) relates to the unfavorable prognosis in post-infarction and/or heart failure patients. However, the prognostic value of HRV in hemodialysis patients has not been fully established.
  
  
  RESULTS
  Time- and frequency-domain analysis of HRV on 24-hour ambulatory electrocardiography recording was assessed prospectively in 383 chronic hemodialysis patients (220 men and 163 women, mean age 57+/-13 years, ejection fraction 65+/-12%). During 2110+/-903 days of follow up, 146 patients died (31 congestive heart failure, 13 fatal myocardial infarction, 13 sudden deaths, 26 stroke, and 63 non-cardiovascular deaths). A Cox univariate analysis identified the following factors as predictors of both all-cause and cardiovascular death: age, gender, ejection fraction, presence of diabetes, and HRV parameters calculated in the time- and frequency-domain. In multivariate analysis, a low standard deviation of all normal RR intervals (SDNN) value was the strongly associated with both all-cause and cardiovascular death (hazard ratios [95% confidence intervals] 0.988 [0.982-0.994] and 0.984 [0.974-0.993], respectively). From Kaplan-Meier survival curves, the incidence of all-cause and cardiovascular death was much greater in patients with a low SDNN (<75 msec), even after adjusting for the presence of diabetes (P<0.0001).
  
  
  CONCLUSIONS
  Decreased HRV on 24-hour ambulatory electrocardiography is an independent predictor of mortality in chronic hemodialysis patients.
authors.affiliation: Department of Cardiology, The Cardiovascular Institute, Tokyo, Japan. oikawa@cepp.ne.jp
authors.forename: Keiko
authors.initials: K
authors.lastname: Oikawa
authors.forename: Reiko
authors.initials: R
authors.lastname: Ishihara
authors.forename: Tomoko
authors.initials: T
authors.lastname: Maeda
authors.forename: Kaori
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Akira
authors.initials: A
authors.lastname: Koike
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawaguchi
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Tabata
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Murotani
authors.forename: Haruki
authors.initials: H
authors.lastname: Itoh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000503:physiopathology* / Q000628:therapy*; D020521:Stroke / Q000401:mortality; D055815:Young Adult