Tachycardia as a predictor of poor survival in chronic haemodialysis patients

High pulse rate is a culprit of all causes of death in the general population, but its relation to death in haemodialysis (HD) patients has not been examined in a large patient cohort.

We examined the relationship between pulse rate (beats per minute, bpm) before an HD session and survival based on the nationwide HD registry of the Japanese Society for Dialysis Therapy. Outcomes were confirmed using the coded ID numbers of both 2005 and 2006 registries. Logistic analyses were performed to determine the effect of pre-HD pulse rate on survival. A total of 147,702 patients (50.5% men; 31.4% with diabetes mellitus; mean age 63.6 years) on HD three times weekly were studied. Mean (SD) pulse rate was 74.6 (12.0) bpm.

The pulse rate distribution was as follows: 0.7% (40-49 bpm), 6.1% (50-59 bpm), 25.3% (60-69 bpm), 38.1% (70-79 bpm), 18.7% (80-89 bpm), 7.9% (90-99 bpm), 2.4% (100-109 bpm) and 0.7% (110-129 bpm). Overall 1-year mortality rate was 6.6%. Compared with the reference pulse rate (60-69 bpm), the odds ratio (95% CI) for 1-year mortality was 1.20 (0.88-1.63, NS: 40-49 bpm), 1.06 (0.93-1.21, NS: 50-59 bpm), 1.13 (1.04-1.22, P = 0.0037: 70-79 bpm), 1.46 (1.33-1.60, P < 0.0001: 80-89 bpm), 1.91 (1.70-2.15, P < 0.0001: 90-99 bpm), 2.61 (2.19-3.10, P < 0.0001: 100-109 bpm), and 2.43 (1.79-3.30, P < 0.0001: 110-129 bpm) after adjusting for age, sex, diabetes mellitus, body mass index, HD duration, serum albumin, haemoglobin, systolic blood pressure, medication for hypertension, and history of acute myocardial infarction.

Survival rate decreased with an increase in the pre-HD pulse rate in chronic HD patients. The causality of this association and the reasons for a better annual mortality rate of 6.6% remain to be clarified.