Relationship Between Electrochemical Skin Conductance And Heart Rate Variability In Patients With Chronic Kidney Disease

Objectives:Cardiovascular disease(CVD)is the main cause of death in patients with chronic kidney disease(CKD).Cardiovascular autonomic neuropathy(CAN)can increase the incidence of CVD and mortality.Heart rate variability(HRV)analysis is currently recognized as a non-invasive evaluation method of autonomic function,and it is a good indicator of autonomic activity.Electrochemical skin conductance(ESC)was recently introduced as a quantitative indicator for the functional evaluation of sweat glands,it has emerged as a useful tool for early screening of CAN.Therefore,we retrospectively analyzes the correlation between ESC and HRV in CKD patients and evaluates whether ESC measurement can be used as an early screening marker of CAN in patients with CKD and provide clinical application basis for early screening of CAN in patients with CKD.Methods:We analyzed retrospectively the clinical and laboratory data of the 249 patients with CKD from 2014 to 2017 at the First Affiliated Hospital of Kunming Medical University.A detailed history of the patients was collected and 24-hour Holter monitoring was performed to collect HRV time domain indices,including the RR interval standard deviation(SDNN),the 5-minute average heart rate standard deviation(SDANN),and Square root of the mean squared differences of successive RR intervals(RMSSD),Percentage of adjacent R-R intervals that varied by more than 50ms(PNN50).ESC were measured using the eZSCAN,including feet ESC,Hands ESC,and mean global electrochemical skin conductance(GIobal ESC)computed as 0.5*(feet ESC + Hands ESC).Collect it for data entry.SPSS 22.0 was used for statistical analysis.Results:1.The measurement of ESC was completed in all subjects without incident:none of the 249 participants experienced any discomfort,and there were no adverse events,complications,or safety concerns.Coefficient of correlation between the right and left side in this population was r = 0.92,P<0.0001 for ESC of hands and r = 0.96,P<0.0001 for ESC of feet2.The patients were divided into HRV decreased group(91 people)and HRV normal group(158 people)using the standard of SDNN<100ms.The age,sex,history of hypertension,history of diabetes,smoking,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),Global ESC were compared.The results showed that patients with hypertension and diabetes were higher in the HRV decreased group than the HRV normal group(P<0.01),SBP,DBP,and 24-hour mean heart rate were lower in the HRV decreased group than the HRV normal group,and compared to the normal group,group with decreased HRV had lower ESC value.There was no significant difference in ESC index between CKD patients with stage 1-3 and CKD patients with stage 4-5.3.The Spearman correlation analysis showed that the ESC was positively correlated with SDNN(P<0.05)and SDANN(P<0.01)and negatively correlated with age,BMI(P<0.05).4.Further analysis by a generalized linear model,age,gender,history of hypertension,history of diabetes,smoking,BMI,SDNN and SDANN were used as covariates,Global ESC as a dependent variable.The results showed that Global ESC was independently associated with age(P<0.001)and SDNN(P<0.05).Conclusions:1.In CKD patients,ESC measures safely and has good limb symmetry.2.In CKD patients,ESC was independently associated with SDNN,suggesting that ESC may serve as an early assessment indicator of CAN in patients with CKD.3.Age is a factor affecting ESC in CKD patients,clinical application of ESC indicators need to consider the impact of the age.