A Joint Evaluation of Impaired Cardiac Sympathetic Responses and Malnutrition-Inflammation Cachexia for Mortality Risks in Hemodialysis Patients

Jia-Feng Chang; Chang-Chin Wu; Chih-Yu Hsieh; Yen-Yao Li; Ting-Ming Wang; Jian-Chiun Liou

doi:10.3389/fmed.2020.00099

A Joint Evaluation of Impaired Cardiac Sympathetic Responses and Malnutrition-Inflammation Cachexia for Mortality Risks in Hemodialysis Patients

Front Med (Lausanne). 2020 Mar 27:7:99. doi: 10.3389/fmed.2020.00099. eCollection 2020.

Authors

Jia-Feng Chang^{1

2

3

4

5

6}, Chang-Chin Wu^{7

8}, Chih-Yu Hsieh⁶, Yen-Yao Li^{9

10}, Ting-Ming Wang¹¹, Jian-Chiun Liou¹²

Affiliations

¹ Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
² Graduate Institute of Aerospace and Undersea Medicine, Academy of Medicine, National Defense Medical Center, Taipei, Taiwan.
³ Division of Nephrology, Department of Internal Medicine, En Chu Kong Hospital, New Taipei City, Taiwan.
⁴ Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan.
⁵ Renal Care Joint Foundation, New Taipei City, Taiwan.
⁶ Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁷ Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan.
⁸ Department of Orthopedics, En Chu Kong Hospital, New Taipei City, Taiwan.
⁹ Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi City, Taiwan.
¹⁰ College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
¹¹ Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
¹² School of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.

Abstract

Background: Cardiac sympathetic response (CSR) and malnutrition-inflammation syndrome (MIS) score are validated assessment tools for patients' health condition. We aim to evaluate the joint effect of CSR and MIS on all-cause and cardiovascular (CV) mortality in patients with hemodialysis (HD). Methods: Changes in normalized low frequency (ΔnLF) during HD were utilized for quantification of CSR. Unadjusted and adjusted hazard ratios (aHRs) of mortality risks were analyzed in different groups of ΔnLF and MIS score. Results: In multivariate analysis, higher ΔnLF was related to all-cause, CV and sudden cardiac deaths [aHR: 0.78 (95% confidence interval (CI): 0.72-0.85), 0.78 (95% CI: 0.70-0.87), and 0.74 (95% CI: 0.63-0.87), respectively]. Higher MIS score was associated with incremental risks of all-cause, CV and sudden cardiac deaths [aHR: 1.36 (95% CI: 1.13-1.63), 1.33 (95% CI: 1.06 - 1.38), and 1.50 (95% CI: 1.07-2.11), respectively]. Patients with combined lower ΔnLF (≤6.8 nu) and higher MIS score were at the greatest risk of all-cause and CV mortality [aHR: 5.64 (95% CI: 1.14-18.09) and 5.86 (95% CI: 1.64-13.65), respectively]. Conclusion: Our data indicate a joint evaluation of CSR and MIS score to identify patients at high risk of death is more comprehensive and convincing. Considering the extremely high prevalence of cardiac autonomic neuropathy and malnutrition-inflammation cachexia in HD population, a non-invasive monitoring system composed of CSR analyzer and MIS score calculator should be developed in the artificial intelligence-based prediction of clinical events.

Keywords: autonomic neuropathy; cardiac sympathetic response; hemodialysis; malnutrition-inflammation score; mortality; protein energy wasting.