Parathyroidectomy Is Associated With Reversed Nondipping Heart Rate That Impacts Mortality in Chronic Kidney Disease Patients.

Abstract

OBJECTIVE:

Nondipping heart rate (HR), defined as a night/day HR ratio >0.90, has been associated with increased mortality in epidemiologic studies. However, its prognostic value in stage 5 chronic kidney disease (CKD5) patients and the effects of parathyroidectomy (PTX) on nondipping HR remain unknown.

METHODS:

This case-control study of 162 healthy controls and 502 CKD5 patients was performed between 2011 and 2018, in which CKD5 patients were further divided into non-PTX (n = 186) and severe secondary hyperparathyroidism (SHPT) with PTX (n = 316) subgroups. Each participant underwent 24-hour Holter monitoring for HR ratio. Mortality was followed up in CKD5 patients (median time: 46.0 months).

RESULTS:

The HR ratio in CKD5 patients was higher than in controls (0.92 ± 0.08 vs 0.81 ± 0.08, P <.001), associated with a 44% increase in mortality risk per 0.1 increment (hazard ratio, 1.44; 95% CI: 1.02-2.03; P =.04), and was positively related to serum intact parathyroid hormone levels (P <.001). PTX reversed nondipping HR in SHPT patients (n = 50, median time: 6.3 months, P <.001). Survival probabilities for PTX (n = 294) were better than non-PTX (n = 47) (hazard ratio, 0.31; 95% CI: 0.14-0.67; P <.01) in SHPT patients (serum intact parathyroid hormone >500.0 pg/mL).

CONCLUSION:

CKD5 patients displayed a nondipping HR pattern, which is a prognostic marker of all-cause mortality. PTX for SHPT patients was associated with a reversal in nondipping HR ratio, which may mediate a better outcome.

• Authors: Ying Cui, Hui Huang, Wenkai Ren, Ying Xu, Xiaoming Zha, Ming Zeng, Zhanhui Gao, Shaowen Tang, Guang Yang, Yaoyu Huang, Fangyan Xu, Hanyang Qian, Wenbin Zhou, Chun Ouyang, Lina Zhang, Xueyan Gao, Jing Zhang, Jing Wang, Jing Guo, Changying Xing, Yongyue Wei, Ningning Wang
• Journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (Endocr Pract) Vol. 28 Issue 2 Pg. 148-158 (Feb 2022) ISSN: 1530-891X [Print] United States
• PMID: 33610808 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 AACE. Published by Elsevier Inc. All rights reserved.

Chemical References

• Parathyroid Hormone

Topics

• Case-Control Studies
• Heart Rate
• Humans
• Hyperparathyroidism, Secondary (surgery)
• Kidney Failure, Chronic
• Parathyroid Hormone
• Parathyroidectomy
• Renal Insufficiency, Chronic