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Heart rate variability in diabetic and non-diabetic renal transplant patients
M Kirvela1, K Salmela, L Toivonen
1Department of Anaesthesia, Helsinki University Central Hospital, Finland.
Background:
Heart rate variability (HRV) has been used to investigate the autonomic modulation of heart rate. Diminished HRV has been observed in diabetic autonomic neuropathy, a condition associated with increased mortality. Uraemia is associated with impaired autonomic function, but reports on the effects of uraemia on HRV are scarce.
Methods:
HRV and its circadian variation were studied in 12 diabetic and 11 non-diabetic renal transplantation and in 12 control patients. HRV in time and frequency domains was determined from 24-hour ECG recordings.
Results:
In the diabetic group, all time domain and frequency domain measures of HRV were markedly reduced (P < 0.05), when compared with the control group, and the circadian variation of HRV was absent. The mean (SD) amplitudes (ms) in the frequency bands were: high frequency: 3 (1), 6 (3) and 15 (3); low frequency: 9 (7), 16 (10) and 25 (8); very low frequency: 14 (8), 23 (12) and 30 (11) in the diabetic and non-diabetic uraemic and in the control patients, respectively. In non-diabetic uraemic patients, a tendency to reduced HRV was observed, but no statistical differences in HRV measures were found when compared with the control group.
Conclusion:
The severe impairment of HRV in patients with end-stage diabetic nephropathy is probably due to autonomic neuropathy and partly also to the co-existing heart diseases. It may be a contributing risk factor for ventricular arrhythmias and sudden death in these patients. Uraemia alone causes similar but less severe changes in HRV.