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Published online before print February 6, 2008
Psychosom Med 2008, doi:10.1097/PSY.0b013e31816477a1
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© 2008 by American Psychosomatic Society

Original Article


Received January 11, 2007
Returned for revision September 26, 2007

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, Shinkan Tokudome , MD, MPH, PhD


Address correspondence and reprint requests to: Masayo Kojima, MD, PhD, E-mail: masayok{at}med.nagoya-cu.ac.jp.


  Abstract

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






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Copyright © 2008 by the American Psychosomatic Society