Detrended Fluctuation Analysis of Heart Rate Dynamics Is an Important Prognostic Factor in Patients with End-Stage Renal Disease Receiving Peritoneal Dialysis

• Published in: PloS one Vol. 11; no. 2; p. e0147282
• Main Authors: Chiang, Jiun-Yang, Huang, Jenq-Wen, Lin, Lian-Yu, Chang, Chin-Hao, Chu, Fang-Ying, Lin, Yen-Hung, Wu, Cho-Kai, Lee, Jen-Kuang, Hwang, Juei-Jen, Lin, Jiunn-Lee, Chiang, Fu-Tien
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01-02-2016; Public Library of Science (PLoS)
• Subjects: Analysis; Autonomic nervous system; Biochemistry; Biology and Life Sciences; Cardiac arrhythmia; Cardiovascular diseases; Care and treatment; Chronic kidney failure; Confidence intervals; Coronary artery disease; Dialysis; Electrocardiography; End-stage renal disease; Female; Health aspects; Heart diseases; Heart Rate; Humans; Incidence; Kidney diseases; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - physiopathology; Kidney transplantation; Male; Measurement; Medicine and Health Sciences; Middle Aged; Mortality; Multivariate Analysis; Nonlinear analysis; Nonlinear Dynamics; Patients; People and Places; Peritoneal Dialysis; Peritoneum; Physiological aspects; Prognosis; Proportional Hazards Models; Research and Analysis Methods; Risk analysis; Variation; Variations; Ventricle; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0147282

Patients with severe kidney function impairment often have autonomic dysfunction, which could be evaluated noninvasively by heart rate variability (HRV) analysis. Nonlinear HRV parameters such as detrended fluctuation analysis (DFA) has been demonstrated to be an important outcome predictor in patients with cardiovascular diseases. Whether cardiac autonomic dysfunction measured by DFA is also a useful prognostic factor in patients with end-stage renal disease (ESRD) receiving peritoneal dialysis (PD) remains unclear. The purpose of the present study was designed to test the hypothesis.
Patients with ESRD receiving PD were included for the study. Twenty-four hour Holter monitor was obtained from each patient together with other important traditional prognostic makers such as underlying diseases, left ventricular ejection fraction (LVEF) and serum biochemistry profiles. Short-term (DFAα1) and long-term (DFAα2) DFA as well as other linear HRV parameters were calculated.
A total of 132 patients (62 men, 72 women) with a mean age of 53.7±12.5 years were recruited from July 2007 to March 2009. During a median follow-up period of around 34 months, eight cardiac and six non-cardiac deaths were observed. Competing risk analysis demonstrated that decreased DFAα1 was a strong prognostic predictor for increased cardiac and total mortality. ROC analysis showed that the AUC of DFAα1 (<0.95) to predict mortality was 0.761 (95% confidence interval (CI). = 0.617-0.905). DFAα1≧ 0.95 was associated with lower cardiac mortality (Hazard ratio (HR) 0.062, 95% CI = 0.007-0.571, P = 0.014) and total mortality (HR = 0.109, 95% CI = 0.033-0.362, P = 0.0003).
Cardiac autonomic dysfunction evaluated by DFAα1 is an independent predictor for cardiac and total mortality in patients with ESRD receiving PD.