What does this research mean for the field?

End-stage renal disease (ESRD) is associated with a high prevalence of autonomic dysfunction, characterized by isolated sympathetic impairment in patients not taking antihypertensive drugs, and combined sympathetic and parasympathetic impairment in those receiving antihypertensive therapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 1, 2003

Revisiting Autonomic Dysfunction in End‐Stage Renal Disease Patients

PICO estructurado

Does antihypertensive therapy affect the pattern of autonomic dysfunction in patients with end-stage renal disease?

Población

62 subjects, including 47 patients with end-stage renal disease (ESRD) (11 not requiring blood pressure medications, 36 receiving antihypertensive therapy) and 15 apparently healthy controls.

Intervención

Antihypertensive therapy

Comparador

ESRD patients not receiving antihypertensive therapy, and healthy controls

Resultado

Autonomic dysfunction assessed by standard noninvasive cardiovascular autonomic tests (sympathetic, parasympathetic, and combined responses)surrogate

ESRD is associated with a high prevalence of autonomic dysfunction, with antihypertensive therapy linked to broader impairment across both sympathetic and parasympathetic branches.

Resumen

BACKGROUND: Autonomic dysfunction is frequent in end-stage renal disease (ESRD) patients, but both the relative involvement of the parasympathetic and sympathetic branches and the role of antihypertensive drugs in this setting are still controversial. The present study addressed these issues employing a battery of standard noninvasive cardiovascular autonomic tests. METHODS: Sympathetic (S) function was evaluated by responses of both systolic blood pressure (BP) to passive tilting and diastolic BP to handgrip; parasympathetic (P) function, through the respiratory sinus arrhythmia test and the heart rate response to the 4-s unloaded exercise test. Additional tests influenced by both branches of the autonomic system (P + S) were accomplished by the assessment of heart rate response to the Valsalva maneuver, handgrip, and tilting. RESULTS: Studied subjects belonged to one of the three groups: ESRD patients not requiring BP medications (n = 11; 8 men, 3 women); ESRD patients receiving antihypertensive therapy (n = 36; 21 men, 15 women); and apparently healthy controls (n = 15; 10 men, 5 women). When the variables grouped according to the branch of the autonomic nervous system predominantly probed were analyzed, only the frequency of impaired sympathetic autonomic responses was higher in ESRD patients not receiving BP drugs compared to controls (55 vs. 23%, P = 0.040). In contrast, when ESRD patients receiving BP drugs were compared to controls, the differences became significant in S, P, and P + S tests (46 vs. 23%, P = 0.045; 22 vs. 3%, P = 0.020; and 34 vs. 13%, P = 0.010, respectively). With the criterion of more than one positive finding in any of the variables examined for diagnosing autonomic dysfunction, the prevalence of autonomic dysfunction was 20% in controls, 64% in ESRD patients not receiving BP drugs (P = 0.005 vs. controls), and 67% in ESRD patients receiving BP drugs (P = 0.043 vs. controls). CONCLUSIONS: ESRD continues to be associated with a high prevalence of autonomic dysfunction. ESRD patients receiving BP drugs were found to have detectable impairment in the entire autonomic system in contrast to those not receiving BP drugs in whom inadequate responses were restricted to the sympathetic branch.

Me gusta

Guardar