Heart rhythm complexity as predictors for the prognosis of end-stage renal disease patients undergoing hemodialysis
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RESEARCH ARTICLE
Open Access
Heart rhythm complexity as predictors for the prognosis of end-stage renal disease patients undergoing hemodialysis Hongyun Liu1, Ping Zhan1, Jinlong Shi2, Minlu Hu1, Guojing Wang1 and Weidong Wang1*
Abstract Background: Heart rhythm complexity, a measure of heart rate dynamics and a risk predictor in various clinical diseases, has not been systematically studied in patients with end-stage renal disease. The aim of this study is to investigate the heart rhythm complexity and its prognostic value for mortality in end-stage renal disease patients undergoing hemodialysis. Methods: To assess heart rhythm complexity and conventional heart rate variability measures, 4-h continuous electrocardiography for a retrospective cohort of 202 ostensibly healthy control subjects and 51 hemodialysis patients with end-stage renal disease were analyzed. Heart rhythm complexity was quantified by the complexity index from the measurement of the multiscale entropy profile. Results: During a follow-up of 13 months, 8 people died in the patient group. Values of either traditional heart rate variability measurements or complexity indices were found significantly lower in patients than those in healthy controls. In addition, the complexity indices (Area 1–5, Area 6–15 and Area 6–20) in the mortality group were significantly lower than those in the survival group, while there were no significant differences in traditional heart rate variability parameters between the two groups. In receiver operating characteristic curve analysis, Area 6–20 (AUC = 0.895, p < 0.001) showed the strongest predictive power between mortality and survival groups. Conclusion: The results suggest that heart rhythm complexity is impaired for patients with end-stage renal disease. Furthermore, the complexity index of heart rate variability quantified by multiscale entropy may be a powerful independent predictor of mortality in end-stage renal disease patients undergoing hemodialysis. Keywords: Complexity, Multiscale entropy, End-stage renal disease, Autonomic nervous system, Heart rate variability
Background End-stage renal disease (ESRD), characterized by permanent loss of renal function, is the final stage in chronic kidney disease that becomes a global health problem with increasing prevalence [1]. Despite recent progress in medical management and dialysis therapy * Correspondence: [email protected] 1 Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Fuxing Road, Beijing 100853, China Full list of author information is available at the end of the article
technique, mortality rates remain high in ESRD patients undergoing hemodialysis. The major causes of ESRD are largely the same causes that contribute to cardiovascular disease [2]. In addition, sudden cardiac death is common in patients receiving hemodialysis and may account for about 30% of overall mortality, which could partly owe to the impairment of the autonomic nervous system (ANS) [3–5]. Identification of
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