Usefulness of the heart rate variability test in predicting intradialytic hypotension in patients undergoing chronic haemodialysis

Abstract Background Intradialytic hypotension (IDH) is the primary complication of haemodialysis; however, its diverse pathophysiology and inconsistent definitions complicate its prediction. Despite using the heart rate variability (HRV) test for IDH prediction, studies on its usefulness for predicting IDH diagnosed per the nadir 90 criterion are lacking. We aimed to evaluate HRV test efficacy and reproducibility in predicting IDH diagnosis based on the nadir 90 criterion. Methods Seventy patients undergoing haemodialysis participated in this multicentre prospective observational study. The HRV test was performed during non-haemodialysis periods, and IDH was monitored during 12 haemodialysis sessions. IDH was diagnosed according to the nadir 90 criterion, defined as a decrease in systolic blood pressure of ≤90 mmHg during haemodialysis. After monitoring, the HRV test was repeated. An HRV–IDH index was developed using multivariate logistic regression analysis employing HRV test parameters. The predictive power of the HRV–IDH index was analysed using the area under the receiver operating characteristics curve (AuROC). Reproducibility was evaluated using correlation analysis of two HRV tests on the same patient. Results There were 37 and 33 patients in the IDH and non-IDH groups, respectively. The HRV–IDH index predicted IDH occurrence with AuROCs of 0.776 and 0.803 for patients who had experienced at least one or repeated IDH episodes, respectively. Spearman's correlation coefficient for HRV–IDH indices was 0.859 for the first and second HRV tests. Conclusions The HRV test holds promise for predicting IDH, particularly for patients with recurring IDH diagnosed based on the nadir 90 criterion.