Association of Postexercise Vagal Dysfunction With Protein-Energy Wasting and Noncardiovascular Outcomes in Patients Receiving Hemodialysis: A Retrospective Cohort Study

Naoto Usui; Junichiro Nakata; Akimi Uehata; Sho Kojima; Hideki Hisadome; Shuji Ando; Masakazu Saitoh; Akihito Inatsu; Takahiko Tsuchiya; Takayuki Mawatari; Yusuke Suzuki

doi:10.1053/j.jrn.2023.11.005

Association of Postexercise Vagal Dysfunction With Protein-Energy Wasting and Noncardiovascular Outcomes in Patients Receiving Hemodialysis: A Retrospective Cohort Study

J Ren Nutr. 2023 Nov 23:S1051-2276(23)00209-1. doi: 10.1053/j.jrn.2023.11.005. Online ahead of print.

Authors

Affiliations

¹ Department of Rehabilitation, Kisen Hospital, Tokyo, Japan; Department of Nephrology, Graduate School of Medicine, Juntendo University, Tokyo, Japan. Electronic address: chokujin.70@gmail.com.
² Department of Nephrology, Graduate School of Medicine, Juntendo University, Tokyo, Japan. Electronic address: jnakata@juntendo.ac.jp.
³ Division of Cardiology, Kisen Hospital, Tokyo, Japan.
⁴ Department of Rehabilitation, Kisen Hospital, Tokyo, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.
⁵ Department of Information Sciences, Tokyo University of Science, Chiba, Japan.
⁶ Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan.
⁷ Division of Nephrology, Kisen Hospital, Tokyo, Japan.
⁸ Division of Internal Medicine, Kisen Hospital, Tokyo, Japan.
⁹ Department of Nephrology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.

PMID: 38000522
DOI: 10.1053/j.jrn.2023.11.005

Abstract

Objective: Postexercise vagal dysfunction is linked to noncardiovascular mortality in hemodialysis patients, but the mechanism is unknown. This study aimed to determine the association of cardiovagal neuropathy with systemic inflammation, protein-energy wasting, and noncardiovascular hospitalization.

Methods: This 2-center retrospective cohort study analyzed data from 280 hemodialysis patients who underwent exercise test. Patients were assessed for heart rate (HR) recovery (bpm) for 1 minute after exercise, a marker of vagal function, and were divided into 3 categories (Low: ≤ 6, Mid: 7-11, High: ≥ 12 bpm). We followed 1-year changes in the systemic inflammation-based prognostic score (Glasgow Prognostic Score [GPS]), body weight, and creatinine generation rate (CGR), an indicator of muscle mass, as well as 2-year hospitalization.

Results: The HR recovery category was associated with serum C-reactive protein and albumin levels and GPS. After 1 year, the low HR recovery category was associated with worsening in GPS (low, 0 [0-0.5]; mid, 0 [0-1]; high, 0 [0-0]), weight (low, 100.0 [96.1-102.5]; mid, 101.3 [98.9-105.0]; high, 100.5 [98.2-102.9]%), and CGR (low, 97.0 [88.5-111.4]; mid, 110.2 [90.9-124.8]; high, 106.2 [95.5-115.5]%), and the correlations with GPS and CGR remained consistent after adjusting for confounders such as exercise capacity and hospitalization during the follow-up period. There were 117 patients hospitalized. Compared to the high HR recovery category, the mid (hazard ratio: 1.8, 95% confidence interval [CI]: 1.1-3.1, P = .02) and low (hazard ratio: 2.4, 95% CI: 1.5-4.0, P = .001) categories were independently associated with an increased risk of all-cause hospitalization. For noncardiovascular disease hospitalization, the low HR recovery category was independently associated with increased risk of hospitalization (hazard ratio: 2.1, 95% CI: 1.2-3.7, P = .007).

Conclusions: Vagal neuropathy in this population can contribute to adverse outcomes associated with systemic inflammation and protein-energy wasting.

Keywords: Vagus nerve; chronic hemodialysis; chronic inflammation; heart rate recovery; protein-energy wasting.