Nephrology Dialysis Transplantation, Vol 13, Issue 7 1702-1708, Copyright © 1998 by Oxford University Press
S Jassal, J Douglas and R Stout
Background: Autonomic neuropathy is frequently present
in dialysis patients. In addition, deterioration of autonomic function
occurs with ageing. This study examines the true prevalence of autonomic
neuropathy in elderly dialysis patients and questions whether the
combination of age and uraemia further increases the chance of dysautonomia
being present. Methods: We compared the results of
five different tests (30 : 15 ratio; Valsalva ratio; heart rate response to
deep breathing and the blood pressure responses to sustained hand grip and
standing) of parasympathetic and combined parasympathetic and sympathetic
dysfunction in older haemodialysis patients (mean age 70.2 years), younger
haemodialysis patients (mean age 48.1 years) and two groups of subjects
with normal renal function (mean age 73.0 years and 42.5 years
respectively). Results: Parasympathetic dysfunction
was most prevalent in older patients on dialysis (65.9%) 95% confidence
intervals 51.4-80.4%), compared with 33.3% (95% confidence intervals
19.0-47.5% in younger dialysis patients), and 11.8 and 0% in the old and
young control groups respectively). Combined parasympathetic and
sympathetic dysfunction was seen in 41.5% (95% confidence intervals
26.5-56.5%) and 11.9% (95% confidence intervals 2.1-56.5%) of the old and
young dialysis patients respectively but not in any of the control
subjects. No interaction was seen between age and subject type.
Conclusions: We conclude that although older dialysis
patients have severe impairment of cardiovascular autonomic innervation,
the prevalence of dysfunction is not higher than would be expected in an
ageing population with uraemia. Key words: ageing;
chronic renal failure; haemodialysis; peritoneal dialysis; parasympathetic
nervous system; sympathetic nervous system
ORIGINAL ARTICLES
Prevalence of central autonomic neuropathy in elderly dialysis patients
The Queen's University of Belfast, UK; Belfast City Hospital, Belfast, UK; Corresponding author at: 24 Wellesley St W, #1203, Toronto, Canada, M4Y 2X6
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