Cardiac Autonomic Neuropathy Predicts All-Cause and Cardiovascular Mortality in Patients With End-Stage Renal Failure: A 5-Year Prospective Study

Doulgerakis, D.; Moyssakis, Ioannis; Kapelios, Chris J.; Eleftheriadou, Ioanna; Chorepsima, Stamatia; Michail, S; Tentolouris, Nikolaοs

doi:10.1016/j.ekir.2017.03.002

Cited by 12 publications

(8 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These findings suggest that the possible cause of this association is sympathetic hyperactivity and a loss of parasympathetic regulation, which lead to an increase in the heart rate [ 79 , 80 ]. The high prevalence of CAN in type 2 diabetes, can synergize with the adverse effects on cardiovascular system induced by other common comorbidities such as hypertension, dyslipidemia and obesity [ 81 , 82 , 83 ] which contribute to premature morbidity and mortality [ 84 , 85 , 86 ]. In our review, the prevalence of erectile dysfunction was higher in type 2 diabetics.…”

Section: Discussionmentioning

confidence: 99%

Differences and Similarities in Neuropathy in Type 1 and 2 Diabetes: A Systematic Review

Sempere-Bigorra

Julián-Rochina

Cauli

2021

JPM

View full text Add to dashboard Cite

Background: Diabetic neuropathy is defined as the dysfunction of the peripheral nervous system in diabetic patients. It is considered a microvascular complication of diabetes mellitus. Its presence is associated with increased morbidity and mortality. Although several studies have found alterations at somatic motor, sensory levels and at the level of autonomic nervous system in diabetic patients, there is not a systematic approach regarding the differences in neuropathy between the major variants of diabetes, e.g., type 1 and 2 diabetes at both neurological and molecular level. Data sources: we systematically (Medline, Scopus, and Cochrane databases) evaluated the literature related to the difference of neuropathy in type 1 and 2 diabetes, differences in molecular biomarkers. Study characteristics: seventeen articles were selected based on pre-defined eligibility criteria. Conclusions: both superficial sensitivity (primarily thermal sensitivity to cold) and deep sensitivity (such as vibratory sensitivity), have been reported mainly in type 2 diabetes. Cardiac autonomic neuropathy is one of the diabetic complications with the greatest impact at a clinical level but is nevertheless one of the most underdiagnosed. While for type 1 diabetes patients most neuropathy alterations have been reported for the Valsalva maneuver and for the lying-to-standing test, for type 2 diabetes patients, alterations have been reported for deep-breathing test and the Valsalva test. In addition, there is a greater sympathetic than parasympathetic impairment, as indicated by the screening tests for autonomic cardiac neuropathy. Regarding subclinical inflammation markers, patients with type 2 diabetes showed higher blood levels of inflammatory markers such as high-sensitivity C-reactive protein, proinflammatory cytokines IL-6, IL-18, soluble cell adhesion molecules and E-selectin and ICAM-1, than in type 1 diabetes patients. By contrast, the blood levels of adiponectin, an adipocyte-derived protein with multiple paracrine and endocrine activities (anti-inflammatory, insulin-sensitizing and proangiogenic effects) are higher in type 1 than in type 2 diabetic patients. This review provides new insights into the clinical differences in type 1 and 2 diabetes and provide future directions in this research field.

show abstract

Section: Discussionmentioning

confidence: 99%

Differences and Similarities in Neuropathy in Type 1 and 2 Diabetes: A Systematic Review

Sempere-Bigorra

Julián-Rochina

Cauli

2021

JPM

View full text Add to dashboard Cite

show abstract

“…At the five-year follow-up, the presence of CAN was found to be an independent predictor of all-cause and CV mortality. In addition to CAN, this study revealed that age, serum triglycerides, and left ventricular ejection fraction were independent risk factors for all-cause mortality in ESRD patients [ 30 ]. The results of our study add clinical evidence establishing cardiac dysautonomia testing as an effective risk stratification modality in patients with ESRD.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Autonomic Neuropathy and its Association with Cardiovascular and All-cause Mortality in Patients with End-stage Renal Disease

Bokhari

Inayat

Jawa

et al. 2018

Cureus

View full text Add to dashboard Cite

BackgroundEnd-stage renal disease frequently leads to increased cardiovascular mortality. Cardiovascular autonomic neuropathy (CAN) may be predictive of cardiac arrhythmias and sudden cardiac death in patients with end-stage renal disease.MethodsA total of 70 patients with end-stage renal disease were included in the study. The assessment of cardiac dysautonomia was based on the four standardized tests performed at the baseline and, again, at the end of the study. The criteria for CAN included at least two abnormal test results.ResultsFifty of 70 patients completed the study and were followed-up after one year. Out of the 50 patients, 44 (88%) had CAN at baseline. Twelve (24%) patients died at the one-year follow-up. Sudden cardiac death was reported in seven out of 12 (58%) patients. All seven patients who died had high dysautonomia scores (three abnormal tests) at the baseline. There was a significantly higher percentage of patients with all four abnormal tests amongst patients who died of any cause (56% vs. 17%; RR 6.07, 95% CI 1.29-28.49; p-value 0.02) or due to sudden cardiac death (43% vs. 10.5%; RR 6.37, 95% CI 1.03-39.36; p-value 0.04). All five patients who did not have CAN at the baseline developed this abnormality on repeat testing after one year.ConclusionThe prevalence of CAN in patients with end-stage renal disease on maintenance hemodialysis was significantly higher. CAN was an independent predictor of all-cause and cardiovascular mortality, which highlights it as a risk stratification tool in patients with end-stage renal disease.

show abstract

“…CAN is associated with worse outcomes of patients and a risk of cardiovascular disease (CVD) in a number of human pathologies. 2 , 3 …”

Section: Introductionmentioning

confidence: 99%

“…CAN is associated with worse outcomes of patients and a risk of cardiovascular disease (CVD) in a number of human pathologies. 2,3 CAN, which has a length-dependent pattern, is a common condition, but it is one of the most overlooked complications of endstage renal disease (ESRD). 3,4 The vagus nerve is responsible for approximately 75% of parasympathetic activity in humans and can be damaged in the early phase of CAN.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 CAN, which has a length-dependent pattern, is a common condition, but it is one of the most overlooked complications of endstage renal disease (ESRD). 3,4 The vagus nerve is responsible for approximately 75% of parasympathetic activity in humans and can be damaged in the early phase of CAN. 5 In this situation, parasympathetic activity contributes to sympathetic predominance.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Improved cardiovascular autonomic function and decreased protein-bound uremic toxins in patients with end-stage renal disease after peritoneal dialysis

et al. 2020

View full text Add to dashboard Cite

Objective Cardiovascular autonomic neuropathy is highly prevalent in patients with end-stage renal disease (ESRD), and it has a high fatality rate. This study aimed to determine whether peritoneal dialysis (PD) improves cardiovascular autonomic function (CAF) and decreases protein-bound uremic toxin (indoxyl sulfate [IS], p-cresyl sulfate [PCS]) levels. Methods IS and PCS levels, and parameters of CAF (heart rate response to deep breathing [HR_DB], the Valsalva ratio, baroreflex sensitivity, and the frequency domain) were prospectively evaluated in 26 patients with ESRD undergoing PD at two time points (pre-PD and 6 months post-PD). For comparison, 19 consecutive patients with pre-dialysis chronic kidney disease and 30 age- and sex-matched healthy volunteers were included as the disease and control groups, respectively. Results Baroreflex sensitivity, HR_DB, and the Valsalva ratio were significantly lower in the ESRD and disease groups than in the control group. IS and PCS levels were significantly higher in the ESRD group than in the control group. Sympathetic/parasympathetic activity was improved after PD. IS levels were significantly decreased after PD and IS level changes were correlated with the frequency domain. Conclusions IS may play a role in cardiovascular autonomic neuropathy, and decreased IS levels after dialysis are associated with sympathetic/parasympathetic activity imbalance.

show abstract

Cardiac Autonomic Neuropathy Predicts All-Cause and Cardiovascular Mortality in Patients With End-Stage Renal Failure: A 5-Year Prospective Study

Cited by 12 publications

References 50 publications

Differences and Similarities in Neuropathy in Type 1 and 2 Diabetes: A Systematic Review

Differences and Similarities in Neuropathy in Type 1 and 2 Diabetes: A Systematic Review

Cardiovascular Autonomic Neuropathy and its Association with Cardiovascular and All-cause Mortality in Patients with End-stage Renal Disease

Improved cardiovascular autonomic function and decreased protein-bound uremic toxins in patients with end-stage renal disease after peritoneal dialysis

Contact Info

Product

Resources

About