Decoding the Risk: Heart Rate Variability as a Powerful Predictor of Sudden Cardiac Death in Chronic Hemodialysis Patients—A 36-Month Prospective Study

Avramovski, Petar and Avramovska, Maja and Nikleski, Zorica and Todorovska, Liljana and Sotiroski, Kosta and Siklovska, Vesna and Trajcevska, Irena and Vasilevski, Saso (2025) Decoding the Risk: Heart Rate Variability as a Powerful Predictor of Sudden Cardiac Death in Chronic Hemodialysis Patients—A 36-Month Prospective Study. Dubai Medical Journal, 8 (2). pp. 1-22. ISSN 2571-726X

Text 30 juni (2025) DUBAI MED J, Decoding the risk, HRV as predictor for SCD in CHP.pdf Download (3MB)

Abstract

Introduction: This study aimed to estimate the impact of the C-reactive protein (CRP),
serum albumin, lipids, and heart rate variability (HRV) on sudden cardiac death (SCD)
in chronic hemodialysis patients (CHPs) to derive the strongest predictor for SCD.
Methods: In this prospective study, 90 CHPs, average age 59.2 ± 11.4 years, were
observed over a three-year follow-up period to detect SCD. HRV, with a focus on
standard deviation of normal-to-normal intervals (SDNN), was measured using a 12-
channel ECG. Peripheral blood samples were obtained from all participants, followed
by routine blood tests: urea, creatinine, lipid status, hemoglobin, hs-CRP, albumin, and
calcium - phosphorus product.
Key Findings: The mean SDNN was 107.97 ± 24.51 ms. Among CHPs, SDNN was
significantly lower in deceased patients (79.20 ± 14.84 ms) compared to survivors
(106.91 ± 23.09 ms, P = 0.0097). The mean survival time for SCD was 34.8 ± 5.3
months. Cox regression coefficients b (-0.1146, 0.1224, 0.0781, and 0.0934), hazard ratio
(HR) (0.8917, 1.1303, 1.0812, and 1.0979), and p-value (0.042, 0.203, 0.680 and 0.378)
for SDNN, hs-CRP, albumin and hemodialysis (HD) duration, respectively, showed
strongest predictive impact for SCD of HRV (SDNN) covariate, with hazard rate
rising by 1.12145 (12.45%) for every single unit decrease of SDNN. Receiver operating
characteristics (ROC) analyses for SDNN were as follows: area under the curve (AUC)
= 0.835 (P < 0.001), with a cut-off value of ≤84 ms (sensitivity 80.0%, specificity =
83.53%). AUC results for covariate albumin (AUC = 0.542, P = 0.766), CRP (AUC = 682,
P = 0.204), and HD duration (AUC = 0.558, P = 0.717) did not reach significance in
predicting the risk for SCD.
Conclusion: HRV proved to be a robust and independent predictor of sudden SCD in
CHPs, with HR increasing by 11.48% for each unit decrease in SDNN (ms). In contrast,
hs-CRP, serum albumin, lipids, and HD did not demonstrate a statistically significant
effect on SCD risk prediction in CHPs.

Item Type:	Article
Subjects:	Scientific Fields (Frascati) > Medical and Health Sciences > Clinical medicine
Divisions:	UKLO Network
Depositing User:	D-r Petar Avramovski
Date Deposited:	17 Nov 2025 11:11
Last Modified:	17 Nov 2025 11:11
URI:	https://eprints.uklo.edu.mk/id/eprint/11187

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