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Published online before print February 6, 2008, 10.1097/PSY.0b013e31816477a1
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Psychosomatic Medicine 70:177-185 (2008)
© 2008 American Psychosomatic Society

ORIGINAL ARTICLES

Loss of Fractal Heart Rate Dynamics in Depressive Hemodialysis Patients

Masayo Kojima, MD, PhD, Junichiro Hayano, MD, PhD, Hidekatsu Fukuta, MD, PhD, Seiichiro Sakata, MD, PhD, Seiji Mukai, MD, PhD, Nobuyuki Ohte, MD, PhD, Hachiro Seno, MD, Takanobu Toriyama, MD, Hirohisa Kawahara, MD, Toshiaki A. Furukawa, MD, PhD and Shinkan Tokudome, MD, MPH, PhD

From the Department of Health Promotion and Preventive Medicine (M.K., S.T.), Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Medical Education (J.H.), Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Center for Mental Health and Care (J.H., T.A.F.), Nagoya City University Hospital, Nagoya, Japan; Department of Cardio-Renal Medicine and Hypertension (H.F., S.S., S.M., N.O.), Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Nagoya Kyoritsu Hospital (H.S., T.T., H.K.), Nagoya, Japan; Department of Psychiatry and Cognitive-Behavioral Medicine (T.A.F.), Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

Address correspondence and reprint requests to Masayo Kojima, Department of Health Promotion and Preventive Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. E-mail: masayok{at}med.nagoya-cu.ac.jp

Objective: To assess the relationship between depression, reduced heart rate (HR) variability, and altered HR dynamics among patients with end-stage renal disease who are receiving hemodialysis (HD) therapy.

Methods: We analyzed the 24-hour electrocardiograms of 119 outpatients receiving chronic HD. HR variability was quantified with the standard deviation of normal-to-normal R-R intervals, the triangular index, and the powers of the high- (HF), low- (LF), very-low (VLF), and ultra-low frequency (ULF) components. Nonlinear HR dynamics was assessed with the short-term ({alpha}1) and long-term ({alpha}2) scaling exponents of the detrended fluctuation analysis and approximate entropy. The depression level was assessed using the Beck Depression Inventory, Second Edition (BDI-II). HR variability and dynamics measurements were compared by gender, diabetes, and depression with adjustment for age and serum albumin concentration.

Results: Most indices of HR variability and dynamics were negatively correlated with age, serum albumin concentration, depression score, and were lower in women and patients with diabetes. The {alpha}2 was inversely associated with these variables. Depressed men had significantly lower HF, LF, VLF, and marginally lower ULF than nondepressed persons after adjustment for diabetes and other covariates; no difference in depression was observed in women. The {alpha}2 showed marginally significant difference in depression independent from gender and diabetes.

Conclusions: Among the patients who received HD, depression is associated with reduced HR variability and loss of fractal HR dynamics. However, the influence of depression on HR variability may vary by gender and physiological backgrounds. Further prospective studies are necessary to confirm their association with poor prognosis.

Key Words: depression • fractal • heart rate variability • hemodialysis • nonlinear

Abbreviations: CHD = coronary heart disease; HR = heart rate; DFA = detrended fluctuation analysis; ApEn = approximate entropy; HD = hemodialysis; ESRD = end-stage renal disease; NKC = Nagoya Kidney Center; AMI = acute myocardial infarction; ECG = electrocardiography; PCR = protein catabolic rate; SDNN = standard deviation of normal-to-normal R-R intervals; HF = high-frequency band; LF = low-frequency band; VLF = very-low-frequency band; ULF = ultra-low-frequency band; SD = standard deviation; mNN = mean normal-to-normal R-R intervals; BDI = Beck Depression Inventory; DSM = Diagnostic and Statistical Manual of Mental Disorders; ANCOVA = analysis of covariance; GLM = general linear model.






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