Elevated resting heart rate is an independent predictor of all-cause death and cardiovascular events in Japanese ambulatory hemodialysis patients

Background Elevated heart rate (HR) is an independent risk factor for all-cause death or cardiovascular events in non-hemodialysis subjects; however, the clinical significance of elevated HR in hemodialysis patients is not well studied. Methods We prospectively evaluated the relationship between HR and adverse outcome in a total of 229 ambulatory hemodialysis patients (57 % men; mean age 62.2 years) recruited from two dialysis clinics in 2009. Mean (SD) HR of this cohort was 74.1 (11.0) beats per minute (bpm). Results Receiver operating characteristic curves identified an HR cut-off level of ≥80 bpm for increased adverse outcome. After a mean follow-up of 525 days (range 7–760 days) a total of 30 primary endpoints (21 all-cause deaths, 4 acute coronary syndromes and 8 strokes) and 38 secondary endpoints (30 primary endpoints, 8 congestive heart failures, and 5 other cardiovascular events) were detected. Cox regression analysis revealed that HR >80 bpm was not an independent predictor of primary endpoints [hazard ratio 1.81, 95 % confidence interval (CI) 0.79–4.11, p = NS], but of secondary endpoints (hazard ratio 2.01, 95 % CI 1.01–4.22, p < 0.05) after adjusting for age, sex, hemodialysis duration, and cardiovascular risks. Conclusions Elevated HR is an independent predictor of all-cause death and cardiovascular events in Japanese ambulatory hemodialysis patients.