There is No Association between Cardiovascular Autonomic Dysfunction and Peripheral Neuropathy in Chronic Hemodialysis Patients

Abstract

Background and PurposeThe potential association between the severity of autonomic dysfunction and peripheral neuropathy has not been extensively investigated, with the few studies yielding inconsistent results. We evaluated the relationship between autonomic dysfunction and peripheral neuropathy in chronic hemodialysis patients in a cross-sectional study.MethodsCardiovascular autonomic function was assessed in 42 consecutive patients with chronic renal failure treated by hemodialysis, using a standardized battery of 5 cardiovascular reflex tests. Symptoms of autonomic dysfunction and of peripheral neuropathy were evaluated using the Autonomic Neuropathy Symptom Score (ANSS) and the Neuropathy Symptoms Score. Neurological deficits were assessed using the Neuropathy Disability Score. Conduction velocities along the sensory and motor fibers of the sural and peroneal nerves were measured. Thermal thresholds were documented using a standardized psychophysical technique.ResultsParasympathetic and sympathetic dysfunction was prevalent in 50% and 28% of cases, respectively. Peripheral neuropathy was identified in 25 cases (60%). The prevalence of peripheral neuropathy did not differ between patients with impaired (55%) and normal (75%) autonomic function (p=0.297; Fisher's exact test). The electrophysiological parameters for peripheral nerve function, neuropathic symptoms, abnormal thermal thresholds, age, gender, and duration of dialysis did not differ significantly between patients with and without autonomic dysfunction. Patients with autonomic dysfunction were more likely to have an abnormal ANSS (p=0.048). The severity of autonomic dysfunction on electrophysiological testing was positively correlated with ANSS (r=0.213, p=0.036).ConclusionsThe present data indicate that although cardiovascular autonomic dysfunction is prevalent among patients with chronic renal failure, it is not associated with the incidence of peripheral neuropathy.

Clinical Characteristics of Patients on Hemodialysis With Peripheral Arterial Disease

“…31 DM often causes a dulling of the sensation of pain, and the prevalence of peripheral neuropathy in patients on HD was 60% to 79%. 32,33 Therefore, a PAD diagnosis based solely on leg symptoms may lead to underdiagnosis of PAD.…”

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

“…The prevalence of CAN on the baseline testing in our study was remarkably high, which was independent of the diabetic status of the participants. Few studies found a varied frequency of CAN in the ESRD population ranging from 38% to 65%; however, the prevalence of CAN in our ESRD population was 88% [ 9 - 11 ] (Figure 2 ).…”

“…Furthermore, CAN has previously been associated with nocturnal hypoxemia, concentric hypertrophy, and remodeling considering it as the potential mechanism whereby hypoxemia triggers CV events in patients with ESRD [ 26 ]. At the same time, it is observed that peripheral sensorimotor neuropathy and degree of CAN have no association in patients on chronic hemodialysis [ 11 ]. Therefore, it indicates the need for discrete evaluation of CAN in patients with ESRD on dialysis, even if they have minimal or advanced peripheral neuropathy.…”

“…Therefore, it indicates the need for discrete evaluation of CAN in patients with ESRD on dialysis, even if they have minimal or advanced peripheral neuropathy. It is also notable that in patients with ESRD who develop CAN, the parasympathetic nervous system involvement slightly supersedes the sympathetic nervous system and these patients frequently develop left ventricular hypertrophy due to reduced vagal tone [ 11 ].…”