Association between heart rate fragmentation and kidney function decline in MESA: evidence consistent with...

Area of Science:

• Nephrology
• Cardiology
• Autonomic Neuroscience

Background:

• Sympathetic overactivity is a known contributor to chronic kidney disease (CKD) pathogenesis.
• The role of the parasympathetic system in maintaining kidney function is less understood.
• Animal models suggest parasympathetic activity influences kidney function via anti-inflammatory and cardiovascular pathways.

Purpose of the Study:

• To investigate the association between heart rate fragmentation (HRF), a novel noninvasive marker of parasympathetic function, and prevalent CKD.
• To examine the relationship between HRF and longitudinal changes in estimated glomerular filtration rate (eGFR) over approximately 5 years.

Main Methods:

• Analysis of 1,388 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with polysomnographic ECG recordings.
• HRF was assessed as a measure of parasympathetic activity.
• Statistical models were used to evaluate associations with CKD likelihood and eGFR decline, adjusting for comorbidities.

Main Results:

• Higher HRF, indicating reduced parasympathetic function, was associated with an increased likelihood of prevalent CKD (RR: 1.15).
• Higher HRF was also linked to a steeper decline in eGFR over time (–0.86 mL/min/1.73 m²/SD increase).
• These associations remained significant after adjusting for age, hypertension, diabetes, and baseline CKD status.

Conclusions:

• Reduced parasympathetic activity, as indicated by higher HRF, is associated with prevalent CKD and accelerated kidney function decline.
• HRF may serve as a noninvasive biomarker for renal disease risk stratification and monitoring.
• Findings support a role for parasympathetic function in renal homeostasis and suggest potential for autonomic-targeted interventions.