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

Jiun Yang Chiang, Jenq Wen Huang, Lian Yu Lin, Chin Hao Chang, Fang Ying Chu, Yen Hung Lin, Cho Kai Wu, Jen Kuang Lee, Juei Jen Hwang, Jiunn Lee Lin, Fu Tien Chiang

Research output: Contribution to journalArticle

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Abstract

Background and Objectives 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. Materials and Methods 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 (DFAá1) and long-term (DFAá2) DFA as well as other linear HRV parameters were calculated. Results 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 DFA¿1 was a strong prognostic predictor for increased cardiac and total mortality. ROC analysis showed that the AUC of DFA¿1 (<0.95) to predict mortality was 0.761 (95% confidence interval (CI). = 0.617.0.905). DFA¿1† 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). Conclusion Cardiac autonomic dysfunction evaluated by DFA¿1 is an independent predictor for cardiac and total mortality in patients with ESRD receiving PD.

Original languageEnglish
Article numbere0147282
JournalPLoS One
Volume11
Issue number2
DOIs
Publication statusPublished - Feb 1 2016
Externally publishedYes

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Dialysis
Peritoneal Dialysis
dialysis
kidney diseases
Chronic Kidney Failure
heart rate
Heart Rate
Mortality
confidence interval
Hazards
Confidence Intervals
Biochemistry
Risk analysis
risk analysis
renal function
ROC Curve
biochemistry
Stroke Volume
cardiovascular diseases
Area Under Curve

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

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

In: PLoS One, Vol. 11, No. 2, e0147282, 01.02.2016.

Research output: Contribution to journalArticle

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. / Detrended Fluctuation Analysis of Heart Rate Dynamics Is an Important Prognostic Factor in Patients with End-Stage Renal Disease Receiving Peritoneal Dialysis. In: PLoS One. 2016 ; Vol. 11, No. 2.
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abstract = "Background and Objectives 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. Materials and Methods 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 (DFA{\'a}1) and long-term (DFA{\'a}2) DFA as well as other linear HRV parameters were calculated. Results 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 DFA¿1 was a strong prognostic predictor for increased cardiac and total mortality. ROC analysis showed that the AUC of DFA¿1 (<0.95) to predict mortality was 0.761 (95{\%} confidence interval (CI). = 0.617.0.905). DFA¿1† 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). Conclusion Cardiac autonomic dysfunction evaluated by DFA¿1 is an independent predictor for cardiac and total mortality in patients with ESRD receiving PD.",
author = "Chiang, {Jiun Yang} and Huang, {Jenq Wen} and Lin, {Lian Yu} and Chang, {Chin Hao} and Chu, {Fang Ying} and Lin, {Yen Hung} and Wu, {Cho Kai} and Lee, {Jen Kuang} and Hwang, {Juei Jen} and Lin, {Jiunn Lee} and Chiang, {Fu Tien}",
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AU - Chiang, Jiun Yang

AU - Huang, Jenq Wen

AU - Lin, Lian Yu

AU - Chang, Chin Hao

AU - Chu, Fang Ying

AU - Lin, Yen Hung

AU - Wu, Cho Kai

AU - Lee, Jen Kuang

AU - Hwang, Juei Jen

AU - Lin, Jiunn Lee

AU - Chiang, Fu Tien

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Background and Objectives 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. Materials and Methods 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 (DFAá1) and long-term (DFAá2) DFA as well as other linear HRV parameters were calculated. Results 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 DFA¿1 was a strong prognostic predictor for increased cardiac and total mortality. ROC analysis showed that the AUC of DFA¿1 (<0.95) to predict mortality was 0.761 (95% confidence interval (CI). = 0.617.0.905). DFA¿1† 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). Conclusion Cardiac autonomic dysfunction evaluated by DFA¿1 is an independent predictor for cardiac and total mortality in patients with ESRD receiving PD.

AB - Background and Objectives 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. Materials and Methods 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 (DFAá1) and long-term (DFAá2) DFA as well as other linear HRV parameters were calculated. Results 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 DFA¿1 was a strong prognostic predictor for increased cardiac and total mortality. ROC analysis showed that the AUC of DFA¿1 (<0.95) to predict mortality was 0.761 (95% confidence interval (CI). = 0.617.0.905). DFA¿1† 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). Conclusion Cardiac autonomic dysfunction evaluated by DFA¿1 is an independent predictor for cardiac and total mortality in patients with ESRD receiving PD.

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