Elevated resting heart rate is associated with mortality in patients with chronic kidney disease

Abstract

A higher heart rate is recognized as an independent risk factor for all-cause mortality and cardiovascular events in the general population. However, the association between elevated heart rate and clinical adverse outcomes in patients with non-dialysis-dependent chronic kidney disease (CKD) has not been sufficiently investigated. A total of 1353 participants enrolled in the Fukushima CKD Cohort Study were examined to investigate associations between resting heart rate and clinical adverse outcomes using Cox proportional hazards analysis. The primary outcome of the present study was all-cause mortality, with cardiovascular events as the secondary outcome. Participants were stratified into four groups based on resting heart rate levels at baseline (heart rate < 70/min, ≥ 70 and < 80/min, ≥ 80 and < 90/min, and ≥ 90/min). During the median observation period of 4.9 years, 123 participants died, and 163 cardiovascular events occurred. Compared with the reference level heart rate < 70/min group, the adjusted hazard ratios (HRs) for all-cause mortality were 1.74 (1.05-2.89) and 2.61 (1.59-4.29) for the heart rate ≥ 80 and < 90/min group and heart rate ≥ 90/min group, respectively. A significantly higher risk of cardiovascular events was observed in the heart rate ≥ 80/min and < 90/min group (adjusted HR 1.70, 1.10-2.62), but not in the heart rate ≥ 90/min group (adjusted HR 1.45, 0.90-2.34). In patients with non-dialysis-dependent CKD, a higher resting heart rate was associated with increased all-cause mortality.

Keywords: Cardiovascular event; Chronic kidney disease; Heart rate; Mortality.

Figure 1

Flow of participants in the present study. CKD, chronic kidney disease.

Figure 2

Distributions and Model 4-adjusted restricted cubic splines comparing the relationship of resting heart rate with clinical outcomes in 1,353 participants with non-dialysis-dependent CKD. Solid lines represent adjusted hazard ratio estimates, and dashed lines represent 95% confidence intervals. A All-cause mortality, B cardiovascular events. Model 4: adjusted for age, sex, body mass index, smoking history, diabetes mellitus, history of cardiovascular disease, eGFR, systolic blood pressure, serum albumin, hemoglobin, proteinuria, use of ACEis or ARBs, and use of β-blockers. eGFR, estimated glomerular filtration rate; ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker.

Figure 3

Subgroup analyses for the primary outcome (all-cause mortality). *p-value for interaction. eGFR, estimated glomerular filtration rate; HR, hazard ratio.

Figure 4

Subgroup analyses for the secondary outcome (cardiovascular events). *p-value for interaction. eGFR, estimated glomerular filtration rate; HR, hazard ratio.