Journal of nephrology · 2026
Nocturnal Respiratory Rate Predicts 3-Year Mortality in Hemodialysis.
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Hannane Nora, Schmaderer Christoph, Mayer Christopher C, Matschkal Julia, Krieter Axel, Braun Jürgen R, Dettenhofer Felicitas, Küchle Claudius, Renders Lutz, Günthner Roman, Wassertheurer Siegfried, Haller Bernhard, Heemann Uwe, Müller Alexander, Schmidt Georg, Malik Marek, Braunisch Matthias C
Аннотация
BACKGROUND: Vital parameters such as respiratory rate are well-established predictors of mortality in emergency medicine. In hemodialysis patients, respiratory rate is influenced by multiple factors, including cardiovascular stress and impaired renal acid-base regulation. We hypothesized that higher respiratory rates in hemodialysis patients are associated with increased mortality.
METHODS: In 364 hemodialysis patients from the ISAR cohort, a large prospective multicenter dialysis cohort, the mean nocturnal respiratory rate between 0 and 5 a.m. was derived from 24-hour Holter ECG recordings. Associations with all-cause and cardiovascular mortality at 3 and 6 years were assessed using univariate and multivariable Cox proportional hazards models, including non-linear spline modeling.
RESULTS: Hemodialysis patients had a mean nocturnal respiratory rate of 20.2 breaths/minute. Individuals with higher respiratory rates were younger, had higher nocturnal heart rates, net ultrafiltration, levels of C-reactive protein, and interleukin-6. After 3 years, nocturnal respiratory rate showed a significant, U-shaped association with mortality in both univariate and multivariable analyses. Patients in the highest and lowest quartiles of respiratory rate had a 2.7-fold increased cardiovascular and a 1.4-fold increased all-cause 3-year mortality, compared to patients in the inner quartiles. The association with cardiovascular mortality was confirmed after multivariate adjustment, but was no longer apparent after 6 years.
CONCLUSIONS: Hemodialysis patients exhibit a mean nocturnal respiratory rate above the physiological range, with a U-shaped association with three-year mortality. These findings may reflect increased cardiopulmonary demand in the hemodialysis population, and that nocturnal respiratory rate may provide valuable additional information for risk stratification.
METHODS: In 364 hemodialysis patients from the ISAR cohort, a large prospective multicenter dialysis cohort, the mean nocturnal respiratory rate between 0 and 5 a.m. was derived from 24-hour Holter ECG recordings. Associations with all-cause and cardiovascular mortality at 3 and 6 years were assessed using univariate and multivariable Cox proportional hazards models, including non-linear spline modeling.
RESULTS: Hemodialysis patients had a mean nocturnal respiratory rate of 20.2 breaths/minute. Individuals with higher respiratory rates were younger, had higher nocturnal heart rates, net ultrafiltration, levels of C-reactive protein, and interleukin-6. After 3 years, nocturnal respiratory rate showed a significant, U-shaped association with mortality in both univariate and multivariable analyses. Patients in the highest and lowest quartiles of respiratory rate had a 2.7-fold increased cardiovascular and a 1.4-fold increased all-cause 3-year mortality, compared to patients in the inner quartiles. The association with cardiovascular mortality was confirmed after multivariate adjustment, but was no longer apparent after 6 years.
CONCLUSIONS: Hemodialysis patients exhibit a mean nocturnal respiratory rate above the physiological range, with a U-shaped association with three-year mortality. These findings may reflect increased cardiopulmonary demand in the hemodialysis population, and that nocturnal respiratory rate may provide valuable additional information for risk stratification.