title: Heart rate variability predicts mortality in peritoneal dialysis patients.
abstract: BACKGROUND
  The predictive value of heart rate variability (HRV) in peritoneal dialysis (PD) has never been tested.
  
  
  METHODS
  In this study, the associations between HRV measures and the mortality in 81 PD patients were analyzed. HRV was measured by using 5-min recordings of a stationary system by a standardized method. Both time domain and frequency domain parameters were analyzed.
  
  
  RESULTS
  During a follow-up period of 43.78 ± 14.77 months, 25 patients died, four patients were transferred to hemodialysis. Of the 81 patients, the time domain parameters, such as the standard deviation of differences between adjacent normal sinus to normal sinus (NN) intervals (SDSD) and the square root of the mean of the squared differences between adjacent normal NN intervals (RMSSD), were higher; the frequency domain parameters, such as the ratio of low-frequency power to high-frequency power (LF/HF) and the normalized LF, were lower, and the normalized HF was higher in the non-survived group as compared with the survived group. A Cox proportional hazards model analysis revealed that, of the HRV measures, decrease of the normalized LF, LF/HF and increase of rMSSD, SDSD, normalized HF had significant predictive value for mortality. After adjustment for other univariate predictors including age, urine volume, renal Kt/V, high-sensitivity C-reactive protein (hs-CRP), the predictive value of decreased LF/HF remained significant. Kaplan-Meier survival analysis showed mortality rate was much higher in patients with a low LF/HF (median value of 1.56).
  
  
  CONCLUSIONS
  The decreases of LF/HF which reflects impaired sympathetic nerve regulation is an independent predictor of mortality in PD patients.
authors.affiliation: a Division of Nephrology , Xiamen University First Hospital , Xiamen , China .|b Division of Nephrology , Peking University Third Hospital , Beijing , China , and.
authors.forename: Juan
authors.initials: J
authors.lastname: Pei
authors.affiliation: b Division of Nephrology , Peking University Third Hospital , Beijing , China , and.
authors.forename: Wen
authors.initials: W
authors.lastname: Tang
authors.affiliation: c Division of Nephrology , Guangdong Provincial Hospital of Traditional Chinese Medicine , China.
authors.forename: Li-Xian
authors.initials: LX
authors.lastname: Li
authors.affiliation: b Division of Nephrology , Peking University Third Hospital , Beijing , China , and.
authors.forename: Chun-Yan
authors.initials: CY
authors.lastname: Su
authors.affiliation: b Division of Nephrology , Peking University Third Hospital , Beijing , China , and.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000379:methods / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013564:Sympathetic Nervous System / Q000503:physiopathology*
chemical_list: D002097:C-Reactive Protein
keywords: Autonomic nervous system; chronic kidney disease; heart rate variability; mortality; peritoneal dialysis