Heart rate variability during hemodialysis is an indicator for long-term vascular access survival in uremic patients

Vascular access (VA) is the lifeline of hemodialysis patients. Although the autonomic nervous system might be associated with VA failure (VAF), it has never been addressed in previous studies. This study aimed to evaluate the predictive values of the heart rate variability (HRV) indices for long-ter...

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Veröffentlicht in:PloS one 2017-03, Vol.12 (3), p.e0172212-e0172212
Hauptverfasser: Huang, Ya-Ting, Chang, Yu-Ming, Chen, I-Ling, Yang, Chuan-Lan, Leu, Show-Chin, Su, Hung-Li, Kao, Jsun-Liang, Tsai, Shih-Ching, Jhen, Rong-Na, Tang, Woung-Ru, Shiao, Chih-Chung
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container_start_page e0172212
container_title PloS one
container_volume 12
creator Huang, Ya-Ting
Chang, Yu-Ming
Chen, I-Ling
Yang, Chuan-Lan
Leu, Show-Chin
Su, Hung-Li
Kao, Jsun-Liang
Tsai, Shih-Ching
Jhen, Rong-Na
Tang, Woung-Ru
Shiao, Chih-Chung
description Vascular access (VA) is the lifeline of hemodialysis patients. Although the autonomic nervous system might be associated with VA failure (VAF), it has never been addressed in previous studies. This study aimed to evaluate the predictive values of the heart rate variability (HRV) indices for long-term VA outcomes. This retrospective study was conducted using a prospectively established cohort enrolling 175 adult chronic hemodialysis patients (100 women, mean age 65.1 ± 12.9 years) from June 2010 to August 2010. Each participant received a series of HRV measurements at enrollment. After a 60-month follow-up period, we retrospectively reviewed all events and therapeutic procedures of the VAs which existed at the enrollment and during the follow-up period. During the 60-month follow-up period, 37 (26.8%) had VAF but 138 (73.2%) didn't. The values of most HRV indices were statistically increased during hemodialysis since initiation in the non-VAF group, but not in the VAF group. Among all participants, the independent indicators for VAF included higher normalized high-frequency (nHF) activity [hazard ratio (HR) 1.04, p = 0.005], lower low-frequency/high-frequency (LF/HF) ratio (HR 0.80, p = 0.015), experience of urokinase therapy (HR 11.18, p = 0.002), percutaneous transluminal angioplasty (HR 2.88, p = 0.003) and surgical thrombectomy (HR 2.36, p = 0.035), as well as higher baseline serum creatinine (HR 1.07, p = 0.027) and potassium level (HR 1.58, p = 0.037). In subgroup analysis, a lower sympathetic activity indicated by lower LF/HF ratio was an independent indicator for VAF (HR 0.61, p = 0.03) for tunneled cuffed catheter, but conversely played a protective role against VAF (HR 1.27, p = 0.002) for arteriovenous fistula. HRV is a useful tool for predicting long-term VAF among hemodialysis patients.
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Although the autonomic nervous system might be associated with VA failure (VAF), it has never been addressed in previous studies. This study aimed to evaluate the predictive values of the heart rate variability (HRV) indices for long-term VA outcomes. This retrospective study was conducted using a prospectively established cohort enrolling 175 adult chronic hemodialysis patients (100 women, mean age 65.1 ± 12.9 years) from June 2010 to August 2010. Each participant received a series of HRV measurements at enrollment. After a 60-month follow-up period, we retrospectively reviewed all events and therapeutic procedures of the VAs which existed at the enrollment and during the follow-up period. During the 60-month follow-up period, 37 (26.8%) had VAF but 138 (73.2%) didn't. The values of most HRV indices were statistically increased during hemodialysis since initiation in the non-VAF group, but not in the VAF group. Among all participants, the independent indicators for VAF included higher normalized high-frequency (nHF) activity [hazard ratio (HR) 1.04, p = 0.005], lower low-frequency/high-frequency (LF/HF) ratio (HR 0.80, p = 0.015), experience of urokinase therapy (HR 11.18, p = 0.002), percutaneous transluminal angioplasty (HR 2.88, p = 0.003) and surgical thrombectomy (HR 2.36, p = 0.035), as well as higher baseline serum creatinine (HR 1.07, p = 0.027) and potassium level (HR 1.58, p = 0.037). In subgroup analysis, a lower sympathetic activity indicated by lower LF/HF ratio was an independent indicator for VAF (HR 0.61, p = 0.03) for tunneled cuffed catheter, but conversely played a protective role against VAF (HR 1.27, p = 0.002) for arteriovenous fistula. HRV is a useful tool for predicting long-term VAF among hemodialysis patients.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0172212</identifier><identifier>PMID: 28249028</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Analysis ; Angioplasty ; Autonomic nervous system ; Biology and Life Sciences ; Cardiovascular disease ; Catheters ; Creatinine ; Diabetes ; Dialysis ; Disease-Free Survival ; Female ; Fistulae ; Follow-Up Studies ; Heart Rate ; Hemodialysis ; Hemodynamics ; Hospitals ; Humans ; Indicators ; Internal medicine ; Male ; Medical instruments ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Mortality ; Nephrology ; Nervous system ; Nursing ; Patient outcomes ; Patients ; Potassium ; Renal Dialysis ; Surgery ; Surgical instruments ; Survival ; Survival Rate ; Thrombosis ; Transplants &amp; implants ; U-Plasminogen activator ; Uremia - mortality ; Uremia - physiopathology ; Uremia - therapy ; Urokinase ; Variability ; Vascular Access Devices ; Venous access</subject><ispartof>PloS one, 2017-03, Vol.12 (3), p.e0172212-e0172212</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Huang et al. 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Although the autonomic nervous system might be associated with VA failure (VAF), it has never been addressed in previous studies. This study aimed to evaluate the predictive values of the heart rate variability (HRV) indices for long-term VA outcomes. This retrospective study was conducted using a prospectively established cohort enrolling 175 adult chronic hemodialysis patients (100 women, mean age 65.1 ± 12.9 years) from June 2010 to August 2010. Each participant received a series of HRV measurements at enrollment. After a 60-month follow-up period, we retrospectively reviewed all events and therapeutic procedures of the VAs which existed at the enrollment and during the follow-up period. During the 60-month follow-up period, 37 (26.8%) had VAF but 138 (73.2%) didn't. The values of most HRV indices were statistically increased during hemodialysis since initiation in the non-VAF group, but not in the VAF group. Among all participants, the independent indicators for VAF included higher normalized high-frequency (nHF) activity [hazard ratio (HR) 1.04, p = 0.005], lower low-frequency/high-frequency (LF/HF) ratio (HR 0.80, p = 0.015), experience of urokinase therapy (HR 11.18, p = 0.002), percutaneous transluminal angioplasty (HR 2.88, p = 0.003) and surgical thrombectomy (HR 2.36, p = 0.035), as well as higher baseline serum creatinine (HR 1.07, p = 0.027) and potassium level (HR 1.58, p = 0.037). In subgroup analysis, a lower sympathetic activity indicated by lower LF/HF ratio was an independent indicator for VAF (HR 0.61, p = 0.03) for tunneled cuffed catheter, but conversely played a protective role against VAF (HR 1.27, p = 0.002) for arteriovenous fistula. HRV is a useful tool for predicting long-term VAF among hemodialysis patients.</description><subject>Aged</subject><subject>Analysis</subject><subject>Angioplasty</subject><subject>Autonomic nervous system</subject><subject>Biology and Life Sciences</subject><subject>Cardiovascular disease</subject><subject>Catheters</subject><subject>Creatinine</subject><subject>Diabetes</subject><subject>Dialysis</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Fistulae</subject><subject>Follow-Up Studies</subject><subject>Heart Rate</subject><subject>Hemodialysis</subject><subject>Hemodynamics</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Indicators</subject><subject>Internal medicine</subject><subject>Male</subject><subject>Medical instruments</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nephrology</subject><subject>Nervous system</subject><subject>Nursing</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Potassium</subject><subject>Renal Dialysis</subject><subject>Surgery</subject><subject>Surgical instruments</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>Thrombosis</subject><subject>Transplants &amp; implants</subject><subject>U-Plasminogen activator</subject><subject>Uremia - mortality</subject><subject>Uremia - physiopathology</subject><subject>Uremia - therapy</subject><subject>Urokinase</subject><subject>Variability</subject><subject>Vascular Access Devices</subject><subject>Venous access</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11r2zAUhs3YWLtu_2BshsHYLpJZH7bkm0Ep2xooFPZ1K44l2VGRrUySw_LvpzRuiUcviixs5Od9j3SOTpa9RsUSEYY-3bjRD2CXGzfoZYEYxgg_yU5RTfCiwgV5evR9kr0I4aYoSsKr6nl2gjmmdYH5aRYvNfiYe4g634I30Bhr4i5XozdDl69175QBuwsm5OmBITeDMhKi83mbpnVDt4ja90kd5GjB5yClDiEPo9-aLdgkyEeveyPzDUSjhxheZs9asEG_mt5n2a-vX35eXC6urr-tLs6vFpLhMi4IV5y2wKDCErGSkqqSVAECqFVbKiXLiiNEATjRLWq0alqKVCUxQqRpSkbOsrcH3411QUwJCwJxRggtC4ITsToQysGN2HjTg98JB0bcLjjfiZQeI60WTLGKQ9G0kmAKSjUpItVaVoQ2LWdt8vo8RRubXiuZTurBzkznfwazFp3bipIQVHOeDD5MBt79GXWIojdBamth0G683TfjmOCyfAxKGCasogl99x_6cCImqoN0VjO0Lm1R7k3FOeWkYmVdF4laPkClofb1TRexNWl9Jvg4EyQm6r-xgzEEsfrx_fHs9e85-_6IXWuwcR2cHaNxQ5iD9ABK70Lwur2vByrEvo_usiH2fSSmPkqyN8e1vBfdNQ75B_IgGrk</recordid><startdate>20170301</startdate><enddate>20170301</enddate><creator>Huang, Ya-Ting</creator><creator>Chang, Yu-Ming</creator><creator>Chen, I-Ling</creator><creator>Yang, Chuan-Lan</creator><creator>Leu, Show-Chin</creator><creator>Su, Hung-Li</creator><creator>Kao, Jsun-Liang</creator><creator>Tsai, Shih-Ching</creator><creator>Jhen, Rong-Na</creator><creator>Tang, Woung-Ru</creator><creator>Shiao, Chih-Chung</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-2220-7574</orcidid></search><sort><creationdate>20170301</creationdate><title>Heart rate variability during hemodialysis is an indicator for long-term vascular access survival in uremic patients</title><author>Huang, Ya-Ting ; 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Although the autonomic nervous system might be associated with VA failure (VAF), it has never been addressed in previous studies. This study aimed to evaluate the predictive values of the heart rate variability (HRV) indices for long-term VA outcomes. This retrospective study was conducted using a prospectively established cohort enrolling 175 adult chronic hemodialysis patients (100 women, mean age 65.1 ± 12.9 years) from June 2010 to August 2010. Each participant received a series of HRV measurements at enrollment. After a 60-month follow-up period, we retrospectively reviewed all events and therapeutic procedures of the VAs which existed at the enrollment and during the follow-up period. During the 60-month follow-up period, 37 (26.8%) had VAF but 138 (73.2%) didn't. The values of most HRV indices were statistically increased during hemodialysis since initiation in the non-VAF group, but not in the VAF group. Among all participants, the independent indicators for VAF included higher normalized high-frequency (nHF) activity [hazard ratio (HR) 1.04, p = 0.005], lower low-frequency/high-frequency (LF/HF) ratio (HR 0.80, p = 0.015), experience of urokinase therapy (HR 11.18, p = 0.002), percutaneous transluminal angioplasty (HR 2.88, p = 0.003) and surgical thrombectomy (HR 2.36, p = 0.035), as well as higher baseline serum creatinine (HR 1.07, p = 0.027) and potassium level (HR 1.58, p = 0.037). In subgroup analysis, a lower sympathetic activity indicated by lower LF/HF ratio was an independent indicator for VAF (HR 0.61, p = 0.03) for tunneled cuffed catheter, but conversely played a protective role against VAF (HR 1.27, p = 0.002) for arteriovenous fistula. HRV is a useful tool for predicting long-term VAF among hemodialysis patients.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28249028</pmid><doi>10.1371/journal.pone.0172212</doi><tpages>e0172212</tpages><orcidid>https://orcid.org/0000-0003-2220-7574</orcidid><oa>free_for_read</oa></addata></record>
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subjects Aged
Analysis
Angioplasty
Autonomic nervous system
Biology and Life Sciences
Cardiovascular disease
Catheters
Creatinine
Diabetes
Dialysis
Disease-Free Survival
Female
Fistulae
Follow-Up Studies
Heart Rate
Hemodialysis
Hemodynamics
Hospitals
Humans
Indicators
Internal medicine
Male
Medical instruments
Medicine
Medicine and Health Sciences
Middle Aged
Mortality
Nephrology
Nervous system
Nursing
Patient outcomes
Patients
Potassium
Renal Dialysis
Surgery
Surgical instruments
Survival
Survival Rate
Thrombosis
Transplants & implants
U-Plasminogen activator
Uremia - mortality
Uremia - physiopathology
Uremia - therapy
Urokinase
Variability
Vascular Access Devices
Venous access
title Heart rate variability during hemodialysis is an indicator for long-term vascular access survival in uremic patients
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