title: Impact of metabolic syndrome and its components on heart rate variability during hemodialysis: a cross-sectional study.
abstract: BACKGROUND
  Both uremia and metabolic syndrome (MetS) affect heart rate variability (HRV) which is a risk factor of poor prognoses. The aim of this study was to evaluate the impact of MetS on HRV among chronic hemodialysis patients.
  
  
  METHODS
  This cross-sectional study was carried out in a teaching hospital in Northern Taiwan from June to August, 2010. Adult patients on chronic hemodialysis without active medical conditions were enrolled. HRV were measured for 4 times on the index hemodialysis day (HRV-0, -1, -2, and -3 at before, initial, middle, and late phases of hemodialysis, respectively), and the baseline demographic data and clinical parameters during the hemodialysis session were documented. Then we evaluated the impacts of MetS and its five components on HRV.
  
  
  RESULTS
  One hundred and seventy-five patients (100 women, mean age 65.1 ± 12.9 years) were enrolled and included those with MetS (n = 91, 52 %) and without MetS (n = 84, 48 %). The patients with MetS(+) had significantly lower very low frequency, total power, and variance in HRV-0, total power and variance in HRV-2, and variance in HRV-3. (all p ≦ 0.05) When using the individual components of MetS to evaluate the impacts on HRV indices, the fasting plasma glucose (FPG) criterion significantly affected most indices of HRV while other four components including "waist circumference", "triglycerides", "blood pressure", and "high-density lipoprotein" criteria exhibited little impacts on HRV. FPG criterion carried the most powerful influence on cardiac ANS, which was even higher than that of MetS. The HRV of patients with FPG(+) increased initially during the hemodialysis, but turned to decrease dramatically at the late phase of hemodialysis.
  
  
  CONCLUSIONS
  The impact of FPG(+) outstood the influence of uremic autonomic dysfunction, and FPG criterion was the most important one among all the components of MetS to influence HRV. These results underscored the importance of interpretation and management for abnormal glucose metabolism.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC.
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Chang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC. chungyy2001@yahoo.com.tw.|Saint Mary's Medicine, Nursing and Management College, No. 100, Ln. 265, Sec. 2, Sanxing Rd., Sanxing Township, Yilan County, 266, Taiwan, ROC. chungyy2001@yahoo.com.tw.
authors.forename: Chih-Chung
authors.identifier: http://orcid.org/0000-0003-2220-7574
authors.initials: CC
authors.lastname: Shiao
authors.affiliation: Department of Nursing, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC.|Graduate Institute of Clinical Medical Sciences, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 33302, Taiwan, ROC.
authors.forename: Ya-Ting
authors.initials: YT
authors.lastname: Huang
authors.affiliation: Department of Nursing, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC.
authors.forename: I-Ling
authors.initials: IL
authors.lastname: Chen
authors.affiliation: Department of Nursing, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC.
authors.forename: Chuan-Lan
authors.initials: CL
authors.lastname: Yang
authors.affiliation: Department of Nursing, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC.
authors.forename: Show-Chin
authors.initials: SC
authors.lastname: Leu
authors.affiliation: Department of Nursing, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC.
authors.forename: Hung-Li
authors.initials: HL
authors.lastname: Su
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC.
authors.forename: Jsun-Liang
authors.initials: JL
authors.lastname: Kao
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC.
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Tsai
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC.
authors.forename: Rong-Na
authors.initials: RN
authors.lastname: Jhen
authors.affiliation: Division of Neurology, Department of Internal Medicine, Saint Mary's Hospital Luodong, No. 160 Chong-Cheng South Road, Loudong, 265, Yilan, Taiwan, ROC.
authors.forename: Ching-Cherng
authors.initials: CC
authors.lastname: Uen
mesh_terms: D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D005215:Fasting / Q000097:blood*; D005260:Female; D006321:Heart / Q000294:innervation*; D006339:Heart Rate; D006784:Hospitals, Teaching; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors; D055105:Waist Circumference
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008055:Lipids
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