Autonomic dysfunction in patients with chronic renal failure

• Published in: Journal of Japanese Society for Dialysis Therapy Vol. 22; no. 11; pp. 1219 - 1223
• Main Authors: Toshima, Hhroko, Matui, Kazutaka, Shimojo, Sadatomo, Miyahara, Tadashi, Toshima, Ryouichi, Hasegawa, Takashi, Miyajima, Masayuki, Kawaguchi, Yoshindo
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society for Dialysis Therapy 1989
• ISSN: 0911-5889; 1884-6211
• DOI: 10.4009/jsdt1985.22.1219

Autonomic functions in patients with chronic renal failure (CRF) were assessed by means of digital plethysmography designed for evaluating both sympathetic and parasympathetic functions. The subjects consisted of 68 patients with CRF due to chronic glomerulonephritis (62 cases). Polycystic kidney disease (3 cases), pyelonephritis (2 cases) and gouty kidney (1 case), excluding all those of SLE or DM origin. The patients were subdivided into five groups: Predialysis group (17 cases), Hemodialysis group (HD, 17 cases), Continuous ambulatory peritoneal dialysis group (CAPD, 18 cases) and 3 cases of kidney transplantation. One-hundred-sixty-six healthy controls were also chosen for the study. Optical plethysmography was recorded for 2 minutes from the second finger of the right hand in a quiet room, and the data was digitally analyzed for the coefficient variation of wave heights (CVWH) and pulse-pulse intervals (CVPP). CVWH and CVPP were 7.44±3.58% and 2.41±0.94% respectively in the predialysis group, 7.57±4.04% and 2.29±0.76% in the HD group, 6.69±2.96% and 1.96±0.83% in the CAPD group and 8.20±1.92% and 3.70±1.32% in the transplanted group. CVWH in each group of CRF patients were significantly decreased as compared with agematched control values. CVPP in dialyzes patients were also decreased significantly as compared with control values. No significant difference was found between the predialysis group and normal controls. There was a positive linear correlation between CVWH and CVPP in the group of patients with CRF and HD. From the above results it is suggested that CVWH and CVPP are significantly decreased in CRF, implying the presence of both sympathetic and parasympathetic dysfunction. It is concluded that dysautonomia as observed in CRF is resistant to dialysis therapy, since no difference in the two parameters was found in the predialysis and dialysis groups and also as both sympathetic and parasympathetic nerve functions were simultaneously affected.