Evaluation of Cardiac Autonomous Functions in Patients with Chronic Glomerulonephritis

Abstract

Aim: Our study aims to investigate the presence of autonomic dysfunction, which is one of the important causes of cardiovascular mortality, by evaluating heart rate variability and heart rate turbulence in patients with chronic glomerulonephritis Material and Methods: In this case-control study, 42 individuals with chronic glomerulonephritis classified as stage 1–3 chronic kidney disease and 102 age- and sex-matched healthy subjects were compared in terms of heart rate variability and heart rate turbulence. Subgroup analyses were performed by dividing the patient group into nephrotic and nephritic syndrome subgroups. p<0.05 was accepted as significant. Results: In the glomerulonephritis group, significant decreases were observed in heart rate variability parameters, indicating that cardiac autonomic functions changed in favor of sympathetic activation. When subgroup analysis was performed, it was observed that the decrease in the parameters representing parasympathetic activation of heart rate variability continued in the nephritic syndrome group. Conclusions: This study demonstrated that autonomic dysfunction characterized by parasympathetic suppression and sympathetic activation is present in patients with chronic glomerulonephritis, even in the early stages of chronic kidney disease.

Keywords

• glomerulonephritis
• cardiac autonomic function
• heart rate variability
• heart rate turbulence

References

1. 1. Sethi S, De Vriese AS, Fervenza FC. Acute glomerulonephritis. The Lancet 2022, 399. 10335:1646–1663.
2. 2. Dickinson BL. Unraveling the immunopathogenesis of glomerular disease. Clin Immunol. 2016;169:89–97.
3. 3. Öztürk S. Primer Glomerüler Hastalıkların Tanı ve Tedavisi: Türk Nefroloji Derneği Ulusal Uzlaşı Raporu. 2019:29–35.
4. 4. Rovin BH, Adler SG, Barratt J, et al. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int. 2021;100(4):1–276.
5. 5. O’brien I, McFadden J, Corrall R. The influence of autonomic neuropathy on mortality in insulin-dependent diabetes. An Int J Med. 1991;79(3):495–502.
6. 6. Schmidt G, Malik M, Barthel P, et al. Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction. Lancet. 1999;353(9162):1390–6.
7. 7. Chandra P, Sands RL, Gillespie BW, et al. Predictors of heart rate variability and its prognostic significance in chronic kidney disease. Nephrol Dial Transplant. 2012;27(2):700–9.
8. 8. Braunisch MC, Mayer CC, Bauer A, et al. Cardiovascular mortality can be predicted by heart rate turbulence in hemodialysis patients. Frontiers Physiol. 2020;11:77.

9. 9. Gamal E, Behairy MA, Mohammed ME, Ahmed EY, Abdel Rahman Ahmed MD. A Study of Cardiac Autonomic Neuropathy among Non-Diabetic Chronic Kidney Disease Patients. The Medical Journal of Cairo University, 2022, 90. 12:2263–2275.
10. 10. Candemir M, Sezenöz B, & Özdemir M. Predictors of Paroxysmal Atrial Fibrillation: Heart Rate Variability and Heart Rate Turbulence. Kafkas Journal of Medical Sciences, 2022, 12(1), 65–70.
11. 11. Kleiger RE, Bigger JT, Bosner MS, et al. Stability over time of variables measuring heart rate variability in normal subjects. Am J Cardiol. 1991;68(6):626–30.
12. 12. Kamath MV, Ghista DN, Fallen EL, Fitchett D, Miller D, McKelvie R. Heart rate variability power spectrogram as a potential noninvasive signature of cardiac regulatory system response, mechanisms, and disorders. Heart Vessels. 1987;3(1):33 41.
13. 13. Lombardi F, Ruscone TG, Malliani A. Premature ventricular contractions and reflex sympathetic activation in cats. Cardiovasc Res. 1989;23(3):205–12.
14. 14. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93(5):1043–65.
15. 15. Watanabe MA. Heart rate turbulence: a review. Indian Pacing Electrophysiol J. 2003;3(1):10.
16. 16. Cygankiewicz I. Heart rate turbulence. Progress Cardiovasc Dis. 2013;56(2):160–71.
17. 17. Esposito P, Palmieri V, Migliaresi P, Pezzullo S, Martino S, Balletta MM. Preclinical cardiovascular abnormalities in patients in early stages of renal disease without nephrotic syndrome. Hypertens Res. 2009;32(12):1155–6.
18. 18. Clyne N, Hellberg M, Kouidi E, Deligiannis A, Höglund P. Relationship between declining glomerular filtration rate and measures of cardiac and vascular autonomic neuropathy. Nephrology. 2016;21(12):1047–55.
19. 19. Hashmi MS, Pandey J. Nephritic Syndrome. 2022 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;2022. PMID:32965911.
20. 20. Haensel A, Mills PJ, Nelesen RA, Ziegler MG, Dimsdale JE. The relationship between heart rate variability and inflammatory markers in cardiovascular diseases. Psychoneuroendocrinology. 2008;33(10):1305–12.
21. 21. Andoh D, Kobayashi M, Yasuda G, et al. Loss of nocturnal decline of blood pressure in non-diabetic patients with nephrotic syndrome in the early and middle stages of chronic kidney disease. Hypertension Res. 2009;32(5):364–8.
22. 22. Drawz PE, Babineau DC, Brecklin C, et al. Heart rate variability is a predictor of mortality in chronic kidney disease: a report from the CRIC Study. Am J Nephrol. 2013;38(6):517–28.
23. 23. Karakayalı M, Artac I, Ilis D, et al. Evaluation of outpatients in the post-COVID-19 period in terms of autonomic dysfunction and silent ischemia. Cureus, 2023, 15(6).