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ORIGINAL RESEARCH article

Front. Neurosci.
Sec. Autonomic Neuroscience
Volume 18 - 2024 | doi: 10.3389/fnins.2024.1429949

Nomogram Model Based on Clinical Factors and Autonomic Nervous System Activity for Predicting Residual Renal Function Decline in Patients Undergoing Peritoneal Dialysis

Provisionally accepted
Jing Wang Jing Wang *Zhenye Chen Zhenye Chen Yaoyu Huang Yaoyu Huang Yujun Qian Yujun Qian Hongqing Cui Hongqing Cui *Li Zhang Li Zhang *Yike Zhang Yike Zhang Ningning Wang Ningning Wang Hongwu Chen Hongwu Chen *Haibin Ren Haibin Ren *Huijuan Mao Huijuan Mao *
  • First Affiliated Hospital, Nanjing Medical University, Nanjing, China

The final, formatted version of the article will be published soon.

    Background: Several heart rate variability (HRV) parameters were reported to be associated with residual renal function (RRF) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). However, it is unclear whether using HRV or other autonomic nervous system (ANS) activity indexes can predict RRF decline in CAPD patients.: Patients undergoing CAPD in 2022 from the First Affiliated Hospital of Nanjing Medical University were enrolled in this study. Their clinical characteristics, 5-min HRV parameters and average voltage of 5-min skin sympathetic nerve activity (aSKNA) were collected. According to the 12-month glomerular filtration rate (GFR) decline rate compared with the upper quartile, these patients were categorized into two groups: RRF decline (RRF-D) group and RRF stable (RRF-S) group. Clinical factors and ANS activity indexes for predicting RRF decline were analyzed using logistic regression, and a nomogram model was further established. The relationships between volume load related indexes and aSKNA were displayed by Spearman's correlation graphs.Results: Ninety-eight patients (53 women, average age of 46.7±13.0 years old) with a median dialysis vintage of 24.5 months were enrolled in this study. 73 patients were categorized into the RRF-S group and 25 patients into the RRF-D group. Compared with RRF-S group, patients in the RRF-D group had higher systolic blood pressure (BP) (p=0.019), higher GFR (p=0.016), higher serum phosphorous level (p=0.030), lower total Kt/V (p=0.001), and lower levels of hemoglobin (p=0.007) and albumin (p=0.010).The RRF-D group generally exhibited lower HRV parameters and aSKNA compared with the RRF-S group. The nomogram model included clinical factors (sex, systolic BP, hemoglobin, GFR, and total Kt/V) and ANS activity indexes (aSKNA) showed the largest AUC of 0.940 (95% CI: 0.890-0.990).The nomogram model included clinical factors (sex, systolic BP, hemoglobin, GFR and total Kt/V) and ANS activity indexes (aSKNA) might be a promising tool for predicting RRF decline in CAPD patients.

    Keywords: Chronic Kidney Disease, Heart rate variability, skin sympathetic nerve activity, Peritoneal Dialysis, Nomogram model

    Received: 09 May 2024; Accepted: 16 Sep 2024.

    Copyright: © 2024 Wang, Chen, Huang, Qian, Cui, Zhang, Zhang, Wang, Chen, Ren and Mao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Jing Wang, First Affiliated Hospital, Nanjing Medical University, Nanjing, China
    Hongqing Cui, First Affiliated Hospital, Nanjing Medical University, Nanjing, China
    Li Zhang, First Affiliated Hospital, Nanjing Medical University, Nanjing, China
    Hongwu Chen, First Affiliated Hospital, Nanjing Medical University, Nanjing, China
    Haibin Ren, First Affiliated Hospital, Nanjing Medical University, Nanjing, China
    Huijuan Mao, First Affiliated Hospital, Nanjing Medical University, Nanjing, China

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