Defective reflex control of heart rate in dialysis patients: evidence for an afferent autonomic lesion.

1. To localize the site of autonomic abnormality in patients undergoing haemodialysis, tests of overall autonomic function based on either changes in blood pressure (posture, sustained handgrip) or heart rate (Valsalva manoeuvre, 30 : 15 ratio, deep breathing test) were used. Integrity of the sympathetic efferent arc was examined by using the cold pressor test and the parasympathetic efferent arc by the atropine test. Eighteen patients and 12 control subjects were studied. 2. Changes in blood pressure in standing, sustained handgrip and in the cold pressor test were the same in the two groups. 3. In contrast, 11 patients had abnormal results in at least two of the three heart-rate-based tests. 4. Three of the 11 dialysis patients with evidence of autonomic involvement showed abnormal responses to atropine, indicating an efferent parasympathetic lesion, whereas the majority had a normal response to the atropine test, suggesting an afferent lesion only. 5. Evidence of autonomic involvement was not associated with hypertension nor confined to patients with dialysis hypotension.

[1]  B. Copeland,et al.  Standard deviation; a practical means for the measurement and control of the precision of clinical laboratory determinations. , 1957, American journal of clinical pathology.

[2]  J. T. Shepherd,et al.  RESPONSE TO EXERCISE IN DOGS WITH CARDIAC DENERVATION. , 1963, The American journal of physiology.

[3]  Joseph W. Linhart,et al.  Effects of Changing Heart Rate in Man by Electrical Stimulation of the Right Atrium: Studies at Rest, during Exercise, and with Isoproterenol , 1965, Circulation.

[4]  A. Levin,et al.  A simple test of cardiac function based upon the heart rate changes induced by the Valsalva maneuver. , 1966, The American journal of cardiology.

[5]  K. Melmon,et al.  Clinical Assessment of Autonomic Function , 1968, Anesthesiology.

[6]  P G Katona,et al.  Cardiac vagal efferent activity and heart period in the carotid sinus reflex. , 1970, The American journal of physiology.

[7]  D L Eckberg,et al.  Defective cardiac parasympathetic control in patients with heart disease. , 1971, The New England journal of medicine.

[8]  D. J. Cunningham,et al.  Effects of Autonomic Blockade on the Baroreflex in Man at Rest and During Exercise , 1972, Circulation research.

[9]  R. Eisinger,et al.  Abnormal response to the Valsalva maneuver in patients on chronic hemodialysis. , 1972, Nephron.

[10]  D. Lowenthal,et al.  The Heart Rate Response to Atropine in Uremic Patients, Obese Subjects Before and During Fasting, and Patients with Other Chronic Illnesses 1 , 1972, Proceedings of the Society for Experimental Biology and Medicine. Society for Experimental Biology and Medicine.

[11]  T. Pickering,et al.  Baroreflex sensitivity in patients on long-term haemodialysis. , 1972, Clinical science.

[12]  K. Cohn,et al.  Autonomic insufficiency in uremia as a cause of hemodialysis-induced hypotension. , 1974, The New England journal of medicine.

[13]  D. Ewing,et al.  Cardiovascular responses to sustained handgrip in normal subjects and in patients with diabetes mellitus: a test of autonomic function. , 1974, Clinical science and molecular medicine.

[14]  D J Ewing,et al.  Autonomic function in patients with chronic renal failure on intermittent haemodialysis. , 1975, Nephron.

[15]  P. Watkins,et al.  Defective innervation of heart in diabetic autonomic neuropathy. , 1975, British medical journal.

[16]  G. Mancia,et al.  Baroreceptor reflexes from different vascular areas in animals and man. , 1976, Clinical science and molecular medicine. Supplement.

[17]  K. Koch,et al.  Plasma noradrenaline levels in regular haemodialysis patients. , 1976, Proceedings of the European Dialysis and Transplant Association. European Dialysis and Transplant Association.

[18]  R. Stone,et al.  Adrenergic regulation of blood pressure in chronic renal failure. , 1976, The Journal of clinical investigation.

[19]  J. Uther,et al.  Autonomic blockade and the Valsalva maneuver in patients on maintenance hemodialysis: a hemodynamic study. , 1977, Kidney international.

[20]  A. Santoro,et al.  Autonomic function in hemodialyzed patients. , 1978, The International journal of artificial organs.

[21]  D. Ewing,et al.  Immediate heart-rate response to standing: simple test for autonomic neuropathy in diabetes. , 1978, British medical journal.

[22]  C. Kjellstrand,et al.  Optimal dialysis frequency and duration: the "unphysiology hypothesis". , 1978, Kidney international. Supplement.

[23]  C. Bach,et al.  Autonomic nervous system disturbance in patients on chronic hemodialysis. , 1979, Israel journal of medical sciences.

[24]  G. Giles,et al.  The effect of haemodialysis and transplantation on autonomic neuropathy. , 1979, Proceedings of the European Dialysis and Transplant Association. European Dialysis and Transplant Association.

[25]  P. Watkins,et al.  Cardiac denervation in diabetic neuropathy. , 1980, Annals of internal medicine.

[26]  E. Whiteside,et al.  EVIDENCE OF VAGAL NEUROPATHY IN CHRONIC ALCOHOLICS , 1980, The Lancet.

[27]  C. Mathias,et al.  Cardiovascular and autonomic reflexes in haemodialysis patients. , 1981, Clinical science.

[28]  R. A. Norman,et al.  Continuous Monitoring of Arterial Pressure Indicates Sinoaortic Denervated Rats Are Not Hypertensive , 1981, Hypertension.