Link between Peripheral Artery Disease and Heart Rate Variability in Hemodialysis Patients

PLoS One. 2015 Aug 3;10(8):e0120459. doi: 10.1371/journal.pone.0120459. eCollection 2015.

Abstract

Peripheral artery disease (PAD) and low heart rate variability (HRV) are highly prevalent in hemodialysis patients, and both are associated with increased cardiovascular morbidity and mortality. This study aims to examine the suggested relationship between PAD and HRV, and the relationship of parameters before and after hemodialysis. This study enrolled 161 maintenance hemodialysis patients. PAD was defined as ABI < 0.9 in either leg. HRV was performed to assess changes before and after hemodialysis. The change in HRV (△HRV) was defined as post-hemodialysis HRV minus pre-hemodialysis HRV. Patients' clinical parameters were collected from the dialysis records. All HRV parameters except high frequency (HF) % were lower in patients with PAD than patients without PAD, though not achieving significant level. In patients without PAD, HF (P = 0.013), low frequency (LF) % (P = 0.028) and LF/HF (P = 0.034) were significantly elevated after hemodialysis, whereas no significant HRV parameters change was noted in patients with PAD. Serum intact parathyroid hormone was independently associated with △HF (β = -0.970, P = 0.032) and △LF% (β = -12.609, P = 0.049). Uric acid level (β = -0.154, P = 0.027) was negatively associated with △LF/HF in patients without PAD. Our results demonstrated that some of the HRV parameters were significantly increased after hemodialysis in patients without PAD, but not in patients with PAD, reflecting a state of impaired sympatho-vagal equilibrium. Severity of secondary hyperparathyroidism and hyperuricemia contributed to lesser HRV parameters increase after hemodialysis in patients without PAD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Electrocardiography
  • Female
  • Heart Rate*
  • Humans
  • Male
  • Middle Aged
  • Peripheral Arterial Disease / physiopathology*
  • Renal Dialysis*

Grants and funding

The research presented in this article is supported by the grant from Kaohsiung Municipal Hsiao-Kang Hospital (kmhk-103-001), Kaohsiung Medical University, Kaohsiung, and the statistical work by the Department of Research Education and Training at Kaohsiung Municipal Hsiao-Kang Hospital. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.