CKD is an enormous public health issue, the tide of which continues to inexorably rise. In the 2015 Global Burden of Disease Study, kidney disease was the 12th most common cause of death, accounting for 1.1 million deaths worldwide. Overall CKD mortality has increased by 31.7% over the last 10 years, making it one of the fastest rising major causes of death, alongside diabetes and dementia.[1]

Important function of the kidneys to rid the body of waste materials that are either ingested or produced by metabolism.[2] Renal failure is defined as deterioration in renal function, sufficient to result in accumulation of nitrogenous waste in the body. It may be rapid and usually reversible in acute renal failure, while it may be slow, more sustained & irreversible deterioration of renal function leading to progressive destruction of nephrons in chronic renal failure (CRF).[3]

CKD is defined as the presence of kidney damage, manifested by abnormal albumin excretion or decreased kidney function, quantified by measured or estimated glomerular filtration rate(GFR), that persists for more than three months.[4,5] This process ultimately results in decreased urine production and kidney failure, with buildup of waste products in the blood and body tissues.[6] The most frequent causes of CKD are diabetic nephropathy, hypertension, glomerulonephritides, interstitial nephritis, pyelonephritis, polycystic kidney disease, obstructive nephropathy. CKD can also be the final result of untreated acute kidney injury (AKI) caused by infections, medicines, toxic substances heavy metals including lead, cadmium, mercury and chromium.[7-9]

The prevalence of these stages of CKD in the US population is as follows: 1.8% for stage 1, 3.2% for stage 2, 7.7% for stage 3 and 0.35 % for stages 4 and 5. Patients with stage 3 or 4 disease progress to end stage renal disease or stage 5 at a rate of 1.5% per year. Stage 1 or 2 CKD patients progress to more advanced stages at approximately 0.5% per year.

CKD is usually asymptomatic until later stages.[10] Sometimes chronic kidney disease is accompanied by high blood pressure, which not only can be caused by kidney damage but also further accelerates kidney injury and is a major reason for the negative effects of chronic kidney disease on other organs, including increased risk of heart disease and stroke, collection of excess body fluids, anemia, weakening of bones, and impairment of the way the body eliminates medications.

A cross-sectional (observational) study was conducted on 100 chronic kidney disease patients (cases) and 100 normal healthy subjects (controls) in age group of 19-60 years. The subjects for study were taken from the patients and their attendants visiting Medicine OPD, in Government Medical College and Rajindra Hospital, Patiala from Nov 2018-Nov 2020 after taking their consent on predesigned proforma.

The subject selection was based on exclusive - inclusive criteria

Inclusion criteria:

1. Individual of age range 19-60 years.

2. All patients of chronic kidney disease presenting in Medicine OPD.

Exclusion criteria:

1. Diagnosed Hypertensives
2. Endocrine Disorders
3. Cardiovascular Disorders
4. Respiratory disorders
5. History of anxiety or depressive disorder

Table 1: Mean and standard deviation of Anthropometric Parameters in Cases and Controls

The mean age (in years) of Control was 37.48±12.52 and Cases was 35.49±11.98. The mean height of Control (in centimeters) was 172.95±7.28and Cases was 171.39±6.56. The mean weight (in kilograms) of Control was 70.10±11.33 and Cases was 67.50±11.19.

Table 2: Baseline variables in Cases and Controls

The mean BMI (kg/m²) of cases was 22.90±3.48 and of controls was 23.38±3.04. The mean BSA (m²) of cases was 1.63±0.24 and of controls was 1.61±0.27.

Table 3: Mean and Standard deviation of B.Urea and S. creatinine of cases and contols

The mean B.Urea (mg/dl) of cases was 90.55±15.62 and of controls was 35.61±10.17. The mean S.Creatinine (mg/dl)of cases was 5.80±2.09 and of controls was 0.93±0.15

Table 4: Mean of Time Domain Analysis in Cases and Controls

The mean RR(s) in cases was 0.74±0.15, controls was 0.78±0.11s. The STD (SDNN)(s) in cases was 0.04±0.03s, controls was 0.05±0.03s. The mean Heart Rate (beats/min) in cases was 81.70±8.34 beats/min, controls was 73.19±9.21 beats/min. The RMSSD (ms) in cases was 25.86±18.04, controls was 32.79±21.52. The NN50 (count) in cases was 9.32±9.05, controls was 10.35±8.30. The pNN50 (%) in cases was 6.09±5.44% and controls was 7.16±5.87%.

Table 5: Mean of Frequency Domain Analysis in Cases and Controls

The VLF peak (Hz) in cases was 0.03±0.01Hz and controls was 0.03±0.01Hz. The LF peak (Hz) in cases was 0.07±0.03 and controls was 0.09±0.08. HF peak (Hz) in cases was 0.18±0.04Hz and controls was 0.20±0.21Hz. VLF power (ms²) in cases was 5.10±7.50ms² and controls was 6.20±8.82ms². LF power (ms²) in cases was 9.22±18.01 ms² and controls was 13.32±25.56ms². HF power (ms²) in cases was 3.46±8.16 ms² and controls was 5.61±10.78 ms². VLF power (%) in cases was 25.33±12.80 ms² and controls was 25.52±16.01 ms². LF power (%) in cases was 54.65±12.13% and controls was 50.64±14.44%. HF power (%) in cases was 20.02±9.47% and controls was 23.84±13.34% .LF/HF ratio in cases was 3.20±1.45 and controls was 2.75±1.59. LF power (nu) in cases was 73.15±11.03 nu and controls was 68.34±13.68nu. HF power (nu) in cases was 26.36±10.22nu and controls was 31.72±13.65nu.

Today, heart problems have become the most frequent cause of death in the western world. The number of sudden cardiac deaths in the United States is estimated between 200.000 and 500.000 per year, with 50% to 70% being due to mechanisms related to arrhythmias.[11]

The mean S. Creatinine was increased in cases (5.80±2.10 mg/dl) as compared to Controls (171.39±6.56 mg/dl). There was statistically highly significant difference in S.Creatinine of Cases and Controls (t= 23.205, p=0.001). The values of mean S.Creatinine in the present study are in agreement with Chandra et al (2012) [12]. This indicates that the kidneys are not functioning properly in the patients with CKD.

The mean STD (SDNN) was increased in Controls (0.05±0.03) and decreased in Cases (0.04±0.03). There was statistically significant difference in Controls and Cases (t=2.589,p=0.010). The values of the mean STD (SDNN) in the present study are in agreement with the values of Fukuta et al (2003),[13]. It has been reported that SDNN and SDANN are influenced by both sympathetic and parasympathetic tone. But the results do not agree with Silva et al (2015)[14]. This may be due to methodological limitations and smaller sample size.

Our present study observed decrease in mean HR in Controls (73.19±9.21) and increase in Cases (81.70±8.34). There was statistically highly significant difference in mean HR in Controls and Cases (t=6.85,p=0.001). This is due to increase in sympathetic tone and decrease in parasympathetic tone. Our study is in agreement with Brotman et al 2010)[15].

The results of the present study demonstrate that the chronic kidney disease patients influence HRV and change the autonomic balance in favor of an increased sympathetic tone. A high sympathetic and a low cardiovagal activity in patients with chronic kidney disease may contribute to the higher cardiac morbidity and mortality of chronic kidney disease patients. Alterations of autonomic nervous system functioning that promotes vagal withdrawal are reflected in reductions of heart rate variability (HRV) indices. CKD patients had a reduced HRV, indicating impaired autonomic function, compared with a reference group without impaired renal function

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