Chronic Renal Failure and Cardiovascular Autonomic Function

Malik, Sujata; Winney, R. J.; Ewing, D J

doi:10.1159/000183828

Cited by 55 publications

(28 citation statements)

References 9 publications

(17 reference statements)

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“…Dys function of the parasympathetic control of the cardio vascular system appeared to be more frequent (36% inci dence) than a damage of the sympathetic control (18%). Such a degree of frequency is lower than that reported elsewhere [4,5,7], It may be explained by the selection we did excluding patients with diseases influencing the cardiovascular-reflex testing, the comparison with ageadjusted normal ranges, and by the criteria we chose to assess the presence of ANS damage.…”

Section: Discussionmentioning

confidence: 75%

“…A defective reg ulation of the heart rate, due mostly to an afferent lesion, appeared more common than damage of reflex blood pressure control in dialysis patients, and studies with adequate control subjects showed a definite parasympa thetic damage in 47-60% of patients [4][5][6][7], Pre-dialysis uraemic patients have been reported to have more exten sive disturbances of ANS than dialysis patients [8,9]. Other investigators [4] on the other hand stated that uraemic ANS dysfunction was not improved by ade quate haemodialysis, whereas successful renal transplan tation reduced the incidence of ANS derangement.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Analysis of Autonomic and Somatic Dysfunction in Chronic Uraemia

et al. 1988

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The relationship between autonomic dysfunction and peripheral somatic neuropathy was investigated in uraemics. The battery of autonomic tests included R-R interval variation test, deep breathing, Valsalva manoeuvre, heart rate and blood pressure responses to standing, and sustained handgrip. Maximum conduction velocity along sensory and motor fibres of the posterior tibial nerve was measured. An impairment of parasympathetic reflexes was more frequent than a sympathetic damage, but with no relationship to the degree of electrophysiological disturbances. Cardiovascular autonomic dysfunction and somatic neuropathy in uraemia result to be two different entities in incidence and perhaps in pathogenesis.

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Autonomic and Somatic Dysfunction in Chronic Uraemia

et al. 1988

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“…On the other hand, no increase in HR was observed in renal dysfunctional dogs, in spite of the continuous reduction in MBP. It is shown that patients with renal dysfunction have autonomic dysfunction [13] and NO reduces sympathetic activity [4]. These results suggest that an excessive production of NO suppresses the sympathetic nerve activity in renal dysfunctional dogs.…”

Section: Discussionmentioning

confidence: 88%

Role of Nitric Oxide in Hemodialysis-Related Hypotension in an Experimental Renal Dysfunction Dog Model

et al. 2004

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ABSTRACT. To clarify the role of nitric oxide (NO) in hemodialysis (HD)-related hypotension, the relationship between plasma NO metabolites (NOx) and blood pressure changes, and the effect of N G -monomethyl-L-arginine (L-NMMA), a NO synthase inhibitor, on changes in blood pressure were evaluated in an experimental renal dysfunctional dog model. In order to create a renal dysfunction model, gentamicin was administered to male beagles in which 7 of 8 renal artery branches had been ligated. Normal renal functional and dy sfunctional dogs underwent 3 hr of HD per day for 3 days. HD induced a transient decrease in mean blood pressure in the normal renal functional dogs. In renal dysfunctional dogs, a continuous hypotension occurred with a gradual increase in the plasma NOx conce ntration during HD. Although L-NMMA prevented the fall in blood pressure, it did not significantly change the plasma NOx concentration during HD. These results suggest that NO contributes to HD-related hypotension in renal dysfunctional dogs but the plasma NOx concentration does not reflect the change in blood pressure. KEY WORDS: hemodialysis-related hypotension, L-NMMA, nitric oxide, renal dysfunctional dog.J. Vet. Med. Sci. 66(1): 53-57, 2004 Hemodialysis (HD) is an established form of therapy for renal dysfunction which has developed since the first study was carried out on a rabbit in 1912 [1]. Nevertheless, HD causes many complications. Hypotension is a major complication of HD that often requires aggressive resuscitation and premature termination of HD. It is widely accepted that many factors influence HD-related hypotension [5].Nitric oxide (NO) is an endogenous vasodilator and an increase in NO synthesis is known to decrease the blood pressure [8,14]. There are some reports suggesting that NO may contribute to HD-related hypotension. It has been shown that there is a correlation between the increase in levels of plasma nitrates and nitrites (NOx) and the reduction in blood pressure in HD patients [12,15]. Methylene blue, a NO inhibitor, prevented hypotension in a few patients undergoing HD therapy [18], but it was conceivable that basic examination concerning an involvement of NO in HDrelated hypotension was insufficient. Interleukin-1 (IL-1) and tumor necrosis factor (TNF) are powerful inducers of the inducible form of NO synthase (iNOS) [6], which causes overproduction of NO [19], and activate constitutive endothelial NO synthase (eNOS) [3]. Plasma levels of these cytokines chronically increase in renal disease patients undergoing HD therapy [6]. The cause may be partly attributable to decreased renal clearance [20]. These results suggest that the ability to produce NO in renal dysfunction is greater than that in normal renal function.Therefore, the present study was devised to establish an experimental renal dysfunctional dog model and to compare this model with a normal animal as to the change in blood pressure in the case of HD. Furthermore, we studied the relationship of NO to HD-related hypotension in this model by measuri...

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“…A single dialysis session has no effect on autonomic function [15]. Results of the studies on the effect of chronic hemodialysis on autonomic function are contradictory, ranging from fair or excellent improvement [16, 17, 18]to indifferent change [13, 19]. However, there are few longitudinal studies on this subject.…”

Section: Discussionmentioning

confidence: 99%

Improvement of Uremic Autonomic Dysfunction after Renal Transplantation: A Heart Rate Variability Study

Yildiz¹,

Sever²,

Demirel

et al. 1998

Nephron

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Autonomic dysfunction in hemodialysis patients is one of the components of uremic neuropathy. In this prospective study, we investigated the effect of renal transplantation on uremic autonomic dysfunction with long-term time-domain and frequency-domain heart rate variability. Fourteen hemodialysis patients (10 male, 4 female; mean age 33 ± 11 (range 16–50) years) were examined before and at the early after transplantation period (mean 4.6 ± 1.5 (range 3–7.5) months). The mean time spent on hemodialysis was 16.7 ± 15.6 (range 6–65) months. In time-domain analysis, significant increases in all parameters except pNN50 (SD, SDANN, SDNN, rMSSD) were observed after renal transplantation (p < 0.01). In frequency-domain analysis, low-frequency (LF) (0.04–0.15 Hz) and high-frequency (HF) (0.15–0.40 Hz) spectral power were found to be significantly increased after renal transplantation (4.54 ± 1.04 vs. 12.58 ± 8.69 for LF (p = 0.005), 2.80 ± 1.0 vs. 6.50 ± 3.55 for HF (p = 0.005)), but the LF/HF ratio was not different from a pretransplant period (1.71 ± 0.349 vs. 1.85 ± 0.49, p = 0.26). It was concluded that autonomic dysfunction in hemodialysis patients is reversible and renal transplantation reverses the sympathetic and parasympathetic autonomic dysfunction simultaneously and at a relatively early stage.

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Chronic Renal Failure and Cardiovascular Autonomic Function

Cited by 55 publications

References 9 publications

Comparative Analysis of Autonomic and Somatic Dysfunction in Chronic Uraemia

Comparative Analysis of Autonomic and Somatic Dysfunction in Chronic Uraemia

Role of Nitric Oxide in Hemodialysis-Related Hypotension in an Experimental Renal Dysfunction Dog Model

Improvement of Uremic Autonomic Dysfunction after Renal Transplantation: A Heart Rate Variability Study

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