title: Associations of parathyroid hormone levels and mineral parameters with heart rate variability in patients with end-stage renal disease.
abstract: OBJECTIVE
  Parathormone (PTH) is a very potent uraemic toxin, which affects calcium/phosphate homeostasis in patients with end-stage renal disease (ESRD). It also plays the role in uraemic autonomic neuropathy. The aim of the study was to investigate the relationship between elevated PTH levels and cardiac autonomic neuropathy assessed by frequency-domain measures of heart rate variability.
  
  
  METHODS
  24-h ECG was performed in 106 ESRD patients and 65 healthy controls. Very-low-frequency (VLF), low-frequency (LF) and high-frequency (HF) bands were computed. LF/HF ratio was calculated.
  
  
  RESULTS
  We found that most heart rate variability indices were lower in ESRD patients than in healthy controls. Variables including demographics (age, sex, body mass index, dialysis vintage, systolic pressure, and diastolic pressure), laboratory values (Hb, Hct, glucose, Alb, and triglyceride), and bone metabolism panel (Ca, P, ALP, and iPTH) were selected as independent variables in the multivariable models. In multivariate analysis, serum intact PTH (iPTH) was correlated with mean normal-to-normal R-R intervals, mean heart rate, and VLF, serum calcium was correlated with standard deviation of 5-min average of normal R-R intervals (SDANN), and serum phosphorus was correlated with VLF and LF/HF. Serum iPTH was independently correlated with mean normal-to-normal R-R intervals (NN), mean HR, and VLF. Serum Ca was independently correlated with SDANN, and serum P was independently correlated with VLF and LF/HF. The results remained significant after the adjustment for iPTH.
  
  
  CONCLUSIONS
  In conclusion, high PTH levels and disorders of mineral metabolism are associated with decreased heart rate variability in ESRD patients.
authors.affiliation: Department of Nephrology, The People's Hospital of Linyicity Shandong Province, No. 27, Jiefang Road, Linyi City, 276003, Shandong Province, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Nephrology, The People's Hospital of Linyicity Shandong Province, No. 27, Jiefang Road, Linyi City, 276003, Shandong Province, China.
authors.forename: Shaoyan
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of Nephrology, The People's Hospital of Linyicity Shandong Province, No. 27, Jiefang Road, Linyi City, 276003, Shandong Province, China. jianlingchen2015@sina.com.
authors.forename: Jianling
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Nephrology, The People's Hospital of Linyicity Shandong Province, No. 27, Jiefang Road, Linyi City, 276003, Shandong Province, China.
authors.forename: Jinling
authors.initials: J
authors.lastname: Ma
authors.affiliation: Department of Nephrology, The People's Hospital of Linyicity Shandong Province, No. 27, Jiefang Road, Linyi City, 276003, Shandong Province, China.
authors.forename: Yueqin
authors.initials: Y
authors.lastname: Ren
mesh_terms: D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood*; D016022:Case-Control Studies; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010530:Peritoneal Dialysis; D010758:Phosphorus / Q000097:blood*; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D010758:Phosphorus; D002118:Calcium
keywords: Parathormone; Renal disease; Serum calcium; Uraemic autonomic neuropathy