Lei Zhang1, Shaoyan Yang1, Jianling Chen2, Jinling Ma1, Yueqin Ren1. 1. Department of Nephrology, The People's Hospital of Linyicity Shandong Province, No. 27, Jiefang Road, Linyi City, 276003, Shandong Province, China. 2. Department of Nephrology, The People's Hospital of Linyicity Shandong Province, No. 27, Jiefang Road, Linyi City, 276003, Shandong Province, China. jianlingchen2015@sina.com.
Abstract
PURPOSE: Parathormone (PTH) is a very potent uraemic toxin, which affects calcium/phosphate homeostasis in patients with end-stage renal disease (ESRD). It also plays the role in uraemic autonomic neuropathy. The aim of the study was to investigate the relationship between elevated PTH levels and cardiac autonomic neuropathy assessed by frequency-domain measures of heart rate variability. METHODS: 24-h ECG was performed in 106 ESRD patients and 65 healthy controls. Very-low-frequency (VLF), low-frequency (LF) and high-frequency (HF) bands were computed. LF/HF ratio was calculated. RESULTS: We found that most heart rate variability indices were lower in ESRD patients than in healthy controls. Variables including demographics (age, sex, body mass index, dialysis vintage, systolic pressure, and diastolic pressure), laboratory values (Hb, Hct, glucose, Alb, and triglyceride), and bone metabolism panel (Ca, P, ALP, and iPTH) were selected as independent variables in the multivariable models. In multivariate analysis, serum intact PTH (iPTH) was correlated with mean normal-to-normal R-R intervals, mean heart rate, and VLF, serum calcium was correlated with standard deviation of 5-min average of normal R-R intervals (SDANN), and serum phosphorus was correlated with VLF and LF/HF. Serum iPTH was independently correlated with mean normal-to-normal R-R intervals (NN), mean HR, and VLF. Serum Ca was independently correlated with SDANN, and serum P was independently correlated with VLF and LF/HF. The results remained significant after the adjustment for iPTH. CONCLUSIONS: In conclusion, high PTH levels and disorders of mineral metabolism are associated with decreased heart rate variability in ESRD patients.
PURPOSE: Parathormone (PTH) is a very potent uraemic toxin, which affects calcium/phosphate homeostasis in patients with end-stage renal disease (ESRD). It also plays the role in uraemic autonomic neuropathy. The aim of the study was to investigate the relationship between elevated PTH levels and cardiac autonomic neuropathy assessed by frequency-domain measures of heart rate variability. METHODS: 24-h ECG was performed in 106 ESRDpatients and 65 healthy controls. Very-low-frequency (VLF), low-frequency (LF) and high-frequency (HF) bands were computed. LF/HF ratio was calculated. RESULTS: We found that most heart rate variability indices were lower in ESRDpatients than in healthy controls. Variables including demographics (age, sex, body mass index, dialysis vintage, systolic pressure, and diastolic pressure), laboratory values (Hb, Hct, glucose, Alb, and triglyceride), and bone metabolism panel (Ca, P, ALP, and iPTH) were selected as independent variables in the multivariable models. In multivariate analysis, serum intact PTH (iPTH) was correlated with mean normal-to-normal R-R intervals, mean heart rate, and VLF, serum calcium was correlated with standard deviation of 5-min average of normal R-R intervals (SDANN), and serum phosphorus was correlated with VLF and LF/HF. Serum iPTH was independently correlated with mean normal-to-normal R-R intervals (NN), mean HR, and VLF. Serum Ca was independently correlated with SDANN, and serum P was independently correlated with VLF and LF/HF. The results remained significant after the adjustment for iPTH. CONCLUSIONS: In conclusion, high PTH levels and disorders of mineral metabolism are associated with decreased heart rate variability in ESRDpatients.
Authors: Allan J Collins; Robert N Foley; Blanche Chavers; David Gilbertson; Charles Herzog; Kirsten Johansen; Bertram Kasiske; Nancy Kutner; Jiannong Liu; Wendy St Peter; Haifeng Guo; Sally Gustafson; Brooke Heubner; Kenneth Lamb; Shuling Li; Suying Li; Yi Peng; Yang Qiu; Tricia Roberts; Melissa Skeans; Jon Snyder; Craig Solid; Bryn Thompson; Changchun Wang; Eric Weinhandl; David Zaun; Cheryl Arko; Shu-Cheng Chen; Frank Daniels; James Ebben; Eric Frazier; Christopher Hanzlik; Roger Johnson; Daniel Sheets; Xinyue Wang; Beth Forrest; Edward Constantini; Susan Everson; Paul Eggers; Lawrence Agodoa Journal: Am J Kidney Dis Date: 2012-01 Impact factor: 8.860
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