Subclinical Cardiovascular Risk Factors in Chronic Kidney Disease: Abnormal Heart Rate Recovery

Abstract

Objective: Chronic kidney disease (CKD) is associated with increased mortality and high cardiovascular (CV) risk. Slow heart rate recovery (HRR) is an index of cardiac autonomic dysfunction and also a prognostic tool for cardiac and all-cause mortality in high-risk groups. In this study, we aimed to investigate the subclinical CV risk factor in different stages of CKD. Materials and Methods: Fifty-one patients with stage 1–5 CKD (mean age, 42.5±8.1 years) and 42 healthy individuals (mean age, 36.0±7.9 years) were included in the study. The HRR was calculated by subtracting the heart rates in the 1st, 2nd, and 3rd minute of the recovery period from the maximum heart rate attained during the exercise stress test. Results: The HRR in the 1st minute was significantly slower in the CKD group compared with that in the control group (22.4±11.3 and 32.4±11.1, respectively; p<0.001). The HRR in the 2nd and 3rd minute was also slower in the patient group, but the difference was not statistically significant. Seventeen patients with the 1st minute HRR ?18 beats/min were mainly distributed in CKD stages 4 and 5. Conclusion: Patients with CKD with no known cardiac disease and no structural cardiac changes were at risk of CV events with a slow HRR in the exercise test. Clinicians should be careful not to underestimate CV events in this group of patients.