2024-혈액투석 환자에서 실시간 심박 변이성을 이용한 투석 효율성 예측 

제1저자: 임성일 (심장내과)

공동 제1저자: 김예나 (장기이식연구소,신장내과)

교신저자: 신호식 (장기이식연구소,신장내과)

Sung Il Im 1,† , Ye Na Kim 2,3,† , Hyun Su Kim 1 , Soo Jin Kim 1, Su Hyun Bae 1, Bong Joon Kim 1, Jung Ho Heo 1,

Yeonsoon Jung 2,3, Hark Rim 2,3 , Sung Pil Cho 4 , Jung Hwan Park 4 and Ho Sik Shin 2,3,*,†

1 Division of Cardiology, Department of Medicine, Kosin University Gospel Hospital,

Kosin University College of Medicine, Busan 606-701, Republic of Korea; sungils8932@naver.com (S.I.I.);

kim.hyunsu100@gmail.com (H.S.K.); circleabc@naver.com (S.J.K.); rodi0203@naver.com (S.H.B.);

bongjoon81@hanmail.net (B.J.K.); duggymdc@gmail.com (J.H.H.)

2 Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine,

Busan 606-701, Republic of Korea; velvetrabbit21@hanmail.net (Y.N.K.); kidney@hanmail.net (Y.J.);

rimhark@hanmail.net (H.R.)

3 Transplantation Research Institute, Kosin University College of Medicine, Busan 606-701, Republic of Korea

4 MEZOO, Won Ju 26354, Republic of Korea; spcho@me-zoo.com (S.P.C.); jhpark@me-zoo.com (J.H.P.)

* Correspondence: 67920@naver.com; Tel.: +81-51-990-6108

† These authors contributed equally to this work.

Abstract: Background: Autonomic dysfunction as a long-term complication may occur in end-stage

kidney disease (ESKD) patients and can be diagnosed using heart rate variability (HRV) analyzed

from electrocardiogram (ECG) recordings. There is limited data about HRV using real-time ECG

to predict hemodialysis (HD) efficiency in patients with ESKD who are routinely doing HD in the

real world. Methods: A total of 50 patients (62.1 ± 10.7 years) with ESKD underwent continuous

real-time ECG monitoring (237.4 ± 15.3 min) during HD for HRV using remote monitoring system.

Their electrolyte levels were checked before and after HD.We compared HRV according to electrolyte

levels. Results: During the monitor, we checked the ECG and electrolyte levels simultaneously a

total of 2374 times for all of the patients. Both time and frequency domain HRV were higher when

the patients had lower K+ level (<0.5 mEq/L) and P+ level change (<2 mEq/L) before and after

HD as compared to those with a higher K+ level (≥0.5 mEq/L) and P+ level change (≥2 mEq/L).

Additionally, patients with lower K+ and P+ level change groups had higher incidences of arrhythmic

events including atrial/ventricular premature complexes, despite no difference of mean heart rate

(p < 0.001). Conclusions: Higher HRV was independently associated with a poorly controlled K+

and P+ level during HD in patients with ESKD. This is consistently evidenced by the independent

association between higher HRV, K+ and P+ levels in real time, suggesting that low electrolyte changes

before and after HD alone may cause cardiac autonomic dysfunction.