Dr Camila Eleuterio Rodrigues1,2,3, Dr Charles Simpson1, Dr Daniel Christiadi1,2, Kylie Taylor1,2, Dr Grant Luxton1,2, Prof Zoltan H. Endre1,2, Dr Jonathan Erlich1,2
1University of New South Wales, Randwick / Sydney, Australia, 2Prince of Wales Hospital, Randwick / Sydney, Australia, 3Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
Aim
To evaluate the post-exercise heart rate variability (HRV) as a determinant of chronic kidney disease (CKD) progression.
Background
Autonomic dysfunction is common in patients with CKD, being associated with severity of the disease. Whether low HRV is a consequence of CKD or a causal factor related with further disease progression is uncertain, and post-exercise HRV has been poorly studied as a predictor of CKD.
Methods
We studied patients with CKD (19 CKD3; 21 CKD4) who performed low impact exercise. Patients were monitored by continuous electrocardiogram, and HRV was analysed. We evaluated the estimated glomerular filtration rate (GFR) of the participants at baseline and after 3 years, and using multiple linear and binomial regression models we assessed HRV as a predictor of long-term kidney outcomes.
Results
Baseline parasympathetic (PNS) activity was lower in CKD4 when compared to CKD3 patients. No parameter was different between CKD groups during and after exercise. However, baseline, exercise and post-exercise HRV predicted long-term kidney outcomes. Low PNS and high SNS activity post-exercise predicted a higher difference between 3-year and baseline GFR (PNS index estimate at 15 min: -3.93, 95%CI:-7.31;-0.54; SNS index estimate at 15 min: 4.19, 95%CI: 1.42;6.97). The percentage of loss of GFR after 3 years was predicted by higher baseline (1.51, 95%CI:0.54; 2.48) and post-exercise heart rates (at 15 min: 1.40, 95%CI: 0.54;2.26).
SNS index at 15 min predicted fast CKD progression, and the low-frequency: high-frequency ratio at 10 min predicted incident end-stage renal disease requiring dialysis.
Conclusions
Exercise-induced increase in SNS and reduction in PNS tonus predicted CKD progression, suggesting that autonomic dysfunction might contribute with CKD progression.
Supported by FAPESP (grant number 2019/19631-7)
Biography:
Graduated in Medicine at University of São Paulo, Brazil, in 2005, and specialised in Nephrology at Hospital das Clínicas, University of São Paulo School of Medicine. PhD in Nephrology obtained in 2015, currently in a Post-Doctorate Fellowship at Prince of Wales Hospital, University of New South Wales, Sydney, Australia.