Parathyroidectomy Is Associated with Reversal in Non-Dipping Heart Rate Which Impact on All-Cause Mortality in Stage 5 Chronic Kidney Disease Patients

Background: Non-dipping heart rate (HR), defined as night/day HR > 0.90, was associated with increased mortality in epidemiological studies. However, its prognostic value in stage 5 chronic kidney disease (CKD5) patients remains unknown. Methods: This case-control study of 162 healthy controls and 502 CKD5 patients, including 316 secondary hyperparathyroidism (SHPT) with parathyroidectomy (PTX) subgroup were enrolled between 2011 and 2018. Each participant underwent 24-hour Holter for HR ratio. Mortality was followed up in CKD5 patients (median time: 46.0 months). Findings: HR ratio in CKD5 patients was higher than controls (0.92±0.08 vs 0.81±0.08, P 500.0 pg/ml). Interpretation: CKD5 patients displayed non-dipping HR pattern which is a prognostic marker of all-cause mortality. PTX for SHPT patients was associated with reversal in non-dipping ratio which may mediate a better outcome. Funding Statement: National Natural Science Foundation of China (81270408, 81570666), International Society of Nephrology Clinical Research Program (18-01-0247), Program of Jiangsu Clinical Research Center (BL2014084), Jiangsu Province Key Medical Personnel Project (ZDRCA2016002). Declaration of Interests: All the authors declared no competing interests. Ethics Approval Statement: All patients and controls participating in the study gave written informed consent, and the study protocol was approved by the Research Ethics Committee of the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (Ethics approval number: 2011-SR-072, 2019-SR-368).