Does dialysis therapy improve autonomic and peripheral nervous system abnormalities in chronic uraemia?

Laaksonen, S.; Voipio‐Pulkki, Liisa‐Maria; Erkinjuntti, M.; Asola, Markku; Falck, Björn

doi:10.1046/j.1365-2796.2000.00690.x

Cited by 47 publications

(40 citation statements)

References 14 publications

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“…Uremia in chronic renal failure may increase the risk of infection (11), polyneuropathy (12), autonomic dysfunction (13), and peripheral vascular disease (14), all of which can be involved in the pathogenesis of LEA. Hemodialysis inadequacy has been found to be associated with mortality due to coronary artery disease, other cardiac disease, cerebrovascular disease, and infection and with allcause mortality (15).…”

Section: Discussionmentioning

confidence: 99%

Diabetes Is the Strongest Risk Factor for Lower-Extremity Amputation in New Hemodialysis Patients

et al. 2004

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OBJECTIVE—End-stage renal disease (ESRD) patients, especially those with diabetes, have an increased risk of nontraumatic lower-extremity amputation (LEA). The present study aims to examine the association of demographic and clinical variables with the risk of hospitalization for LEA among incident hemodialysis patients. RESEARCH DESIGN AND METHODS—The study population consisted of incident hemodialysis patients from the study years 1996–1999 of the ESRD Core Indicator/Clinical Performance Measures (CPM) Project. Cox proportional hazard modeling was used to identify factors associated with LEA. RESULTS—Four percent (116 of 3,272) of noncensored incident patients had an LEA during the 12-month follow-up period. Factors associated with LEA included diabetes as the cause of ESRD or preexisting comorbidity (hazard ratio 6.4, 95% CI 3.4–12.0), cardiovascular comorbidity (1.8, 1.2–2.8), hemodialysis inadequacy (urea reduction ratio [URR] <58.5% (1.9, 1.1–3.3), and lower serum albumin level (1.6, 1.1–2.3). Among patients with diabetes, hemodialysis inadequacy and cardiovascular comorbidity were risk factors for LEA (2.6, 1.4–4.8, and 1.7, 1.1–2.6, respectively). CONCLUSIONS—These data suggest that diabetes is a potent risk factor for LEA in new hemodialysis patients. In ESRD patients with diabetes, a multipronged approach may reduce the rate of LEA. Potentially beneficial strategies include adherence to hemodialysis adequacy guidelines, aggressive treatment of cardiovascular comorbidities, and the utilization of LEA prevention strategies recommended for the general population of patients with diabetes.

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Section: Discussionmentioning

confidence: 99%

Diabetes Is the Strongest Risk Factor for Lower-Extremity Amputation in New Hemodialysis Patients

et al. 2004

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“…Systolic blood pressure declined more than 2 mmHg at 6 and 12 months, and diastolic blood pressure declined 16.6 ± 5.4 mmHg and 6.6 ± 6.4 mmHg in parallel (25). In other studies in HD patients, HD sessions were noted to improve HRV (30,31), an effect that can be interpreted as a consequence of better removal of uremic toxins, as well as better control of extracellular volume.…”

Section: Discussionmentioning

confidence: 70%

Effect of Icodextrin on Heart Rate Variability in Diabetic Patients on Peritoneal Dialysis

et al. 2014

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♦ Introduction: Spectral analysis of heart rate variability is a noninvasive method for evaluating autonomic cardiovascular dysfunction under various clinical conditions, such as in dialysis patients, in whom an imbalance between the sympathetic and parasympathetic nervous system appears to be an important risk factor for sudden cardiovascular death and arrhythmia. ♦ Objective: We compared the effect of icodextrin-based dialysis solution, an option that allows for better metabolic and fluid overload control, with that of glucose-based dialysis fluid on sympathetic and parasympathetic activity in the heart, as assessed by heart rate variability, in diabetic patients on peritoneal dialysis (PD). ♦ Methods: This secondary analysis uses data from a randomized controlled trial in diabetic PD patients with high or high-average peritoneal transport using icodextrin-based (ICO group, n = 30) or glucose-based (GLU group, n = 29) solutions for the long dwell. All patients underwent 24-hour electrocardiographic Holter monitoring at baseline, and at 6 and 12 months of follow-up. ♦ Results: We observed no significant differences between the groups in most of the variables analyzed, although values were, in general, below reference values. In the ICO group, total power and both low-and high-frequency power in normalized units increased, but the percentage of RR intervals with variation of more than 50 ms declined over time; in the GLU group, all those values declined. Plasma catecholamine levels were higher at baseline and declined over time. ♦ Conclusions: These results indicate a partial recovery of sympathetic activity in the ICO group, probably because of better extracellular fluid control and lower exposure to glucose with the use of icodextrin-based dialysis solutions.

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“…However, the study of ANF in ESRD especially in PD patients is still limited. Laaksonen et al [29] showed that the adequacy of dialysis may be a predictor of improvement of cardiac ANF and Dursun et al [30] suggested that dialysis can cause a significant improvement in ANF in CAPD patients. However, the relationship between HRV and RRF which is crucial for PD has not been elucidated by the previous studies.…”

Section: Discussionmentioning

confidence: 99%

Heart Rate Variability in Peritoneal Dialysis Patients: What Is the Role of Residual Renal Function?

Tang¹,

Li²,

Perucho³

et al. 2012

Blood Purif

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Background: The relationship between heart rate variability (HRV) and residual renal function (RRF) has not been elucidated previously. Methods: In this cross-sectional study, HRV was evaluated in 71 peritoneal dialysis patients. Patients were divided into RRF decline group, RRF stable group and anuric group. Results: RRF was negatively correlated with SDNN (r = –0.284, p = 0.017), TP (r = –0.247, p = 0.039), and HF (r = –0.238, p = 0.047). Significant sympathetic nerve activation was found in the RRF decline group (significantly lower SDNN, SDSD, RMSSD, pNN50, LF, HF, TP and higher LF/HF ratio) as compared to the RRF stable and anuric groups. Besides, significantly parasympathetic activation was found in the anuric group (the lowest LF/HF ratio as compared to the other groups (both p < 0.05). Multivariate stepwise regression analysis showed that the status of RRF was an independent factor associated with HRV parameters. Conclusion: This study showed autonomic nervous function in peritoneal dialysis patients was associated with a different status of RRF.

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Does dialysis therapy improve autonomic and peripheral nervous system abnormalities in chronic uraemia?

Cited by 47 publications

References 14 publications

Diabetes Is the Strongest Risk Factor for Lower-Extremity Amputation in New Hemodialysis Patients

Diabetes Is the Strongest Risk Factor for Lower-Extremity Amputation in New Hemodialysis Patients

Effect of Icodextrin on Heart Rate Variability in Diabetic Patients on Peritoneal Dialysis

Heart Rate Variability in Peritoneal Dialysis Patients: What Is the Role of Residual Renal Function?

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