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Updated: May 4, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Relationship between heart rate variability and pulse wave velocity and their association with patient outcomes in
Preeti Chandra1, Robin L Sands, Brenda W Gillespie
1Department of Internal Medicine, University of Maryland, Baltimore, MD, University of Michigan-Kidney Epidemiology and Cost Center, Ann Arbor, MI, Renal Research Institute, New York, NY, Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, Hospital of St. Raphael Yale University, New Haven, CT, Department of Internal Medicine, University of North Carolina, Chapel Hill, NC, Department of Cardiovascular Medicine, Ohio State University, Columbus, OH, Oakwood Healthcare System, Dearborn, MI, and Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Insights
Low heart rate variability (HRV) and high pulse wave velocity (PWV) are independently linked to cardiovascular disease (CVD) and death risk in chronic kidney disease (CKD) patients. The combination of low HRV and high PWV indicates the highest risk.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Biomedical Engineering
Background:
- Arterial stiffness (measured by pulse wave velocity, PWV) and low heart rate variability (HRV) are linked to cardiovascular risk.
- These factors are explored in patients with chronic kidney disease (CKD) stages 3-5.
Purpose of the Study:
- To investigate the relationship between HRV and PWV in CKD patients.
- To examine the association of HRV and PWV with cardiovascular disease (CVD), death, and end-stage renal disease (ESRD).
Main Methods:
- Prospective cohort study (RRI-CKD Study) of 834 CKD stages 3-5 patients.
- A subset (n=240) underwent HRV testing and carotid-femoral PWV measurement.
- Regression analyses were used to assess predictors of PWV and the association of HRV/PWV with clinical outcomes.
Main Results:
- The inverse association between HRV and PWV was attenuated by age, diabetes, and C-reactive protein (inflammation).
- Both low HRV and high PWV were individually associated with increased risk of CVD/death.
- Patients with both low HRV and high PWV had the highest risk of the composite CVD/death endpoint.
Conclusions:
- Inflammation, age, and diabetes explain the HRV-PWV association in CKD.
- Inflammation may contribute to both low HRV and high PWV.
- The combination of low HRV and high PWV is strongly associated with adverse cardiovascular outcomes in CKD, warranting further investigation.
Background:
Arterial stiffness and low heart rate variability (HRV) have each been associated with increased cardiovascular risk in a variety of patient populations. We explored the relationship between HRV and pulse wave velocity (PWV measure of arterial stiffness) in patients with chronic kidney disease (CKD prior to ESRD) along with examining their association with the outcomes of cardiovascular disease (CVD), death, and progression to end stage renal disease (ESRD).
Methods:
The RRI-CKD Study is a 4-center prospective cohort study of CKD stages 3 - 5 (n = 834). A subset underwent both HRV testing by 24-hour Holter and carotid-femoral PWV (n = 240). Multiple linear regression was used to assess predictors of PWV and Cox regression to investigate the association of HRV and PWV with time to first CVD event or death and ESRD.
Results:
Although several HRV measures were inversely correlated with PWV, this association was attenuated after adjustment for age and/or diabetes and no longer significant after adjustment for C-reactive protein. Low HRV and high PWV were individually associated with increased risk of the composite endpoint of CVD/death in multivariable analysis. The risk of the composite of CVD/death was highest for patients with both low HRV and high PWV.
Conclusion:
Age, diabetes, and inflammation together explained the inverse association between HRV and PWV. Inflammation may play a role in the pathogenesis of both low HRV and high PWV. The combination of low HRV and high PWV showed the strongest association with a composite CVD outcome. Mechanisms underlying abnormalities in PWV and HRV, and the role of these measures as intermediate outcomes in future trials in CKD patients, merit further study.
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