Autonomic nervous system dysfunction in chronic uraemics on haemodialysis.
ABSTRACT: AIMS: 1. To determine the prevalence of autonomic neuropathy in nondaibetic uraemics on maintenance hemodialysis and to grade the severity of autonomic dysfunction. 2. To observe the association of symptoms of autonomic neuropathy with the autonomics tests. 3. To observe the association...
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c1999.
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| LEADER | 06309 a2200241 4500 | ||
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| 003 | OSt | ||
| 005 | 20220906184542.0 | ||
| 008 | 190124b ||||| |||| 00| 0 eng d | ||
| 952 | |0 0 |1 0 |2 NLM |4 0 |6 THS_00022_MAH_1999_000000000000000 |7 0 |9 472 |a NHRC |b NHRC |c REF |d 2012-07-11 |l 0 |o THS-00022/MAH/1999 |p THS-00022 |r 2012-07-11 |w 2012-07-11 |y TR | ||
| 999 | |c 466 |d 466 | ||
| 060 | |a THS00022 | ||
| 100 | |a Mahto, Rajni. |9 1599 | ||
| 245 | |a Autonomic nervous system dysfunction in chronic uraemics on haemodialysis. | ||
| 260 | |a c1999. | ||
| 300 | |a 82p. | ||
| 500 | |a Thesis Report. | ||
| 520 | |a ABSTRACT: AIMS: 1. To determine the prevalence of autonomic neuropathy in nondaibetic uraemics on maintenance hemodialysis and to grade the severity of autonomic dysfunction. 2. To observe the association of symptoms of autonomic neuropathy with the autonomics tests. 3. To observe the association of abnormal autonomic tests with duration of uraemic symptoms and duration of dialysis. Method: A cross-sectional case control study of non diabetic chronic uraemics and requisite controls was done between August 1998 to July 1999. This study included 30 consecutive non diabetic chronic uraemic, above the age of 16. They were attending Bir Hospital, a tertiary referral centre, on an out patient basis for maintenance haemodailysis twice a week. Each session of haemodialysis lasted for four hours. 19 age matched healthy volunteers from among the hospital staffs were taken as controls. Tests of autonomic functions were carried out in the patients on a dialysis free day. A battery of five cardiovascular reflex tests was performed for autonomic function testing. The tests undertaken were: 1. Heart rate response to Valsalva manoeuvre. 2. Heart rate response to deep breathing. 3. Heart rate response to standing. 4. Blood pressure response to standing. 5. Blood pressure response to handgrip. A continuous ECG recording was done while the subjects performed the heart rate tests, from which the results of the tests were calculate. Blood pressure was measured while performing BP tests. Results of all tests were individually grouped as normal, borderline and abnormal. Autonomic neuropathy was classified on the basis of severity of damage into one of the five groups. 1. Normal- all five tests normal or one borderline. 2. Early - one of the three heart rate tests abnormal or two borderline. 3. Definite - two or more of the heart rate tests abnormal. 4. Severe- two or more of the heart rate tests abnormal, plus one or both of the blood pressure tests abnormal or both borderline. 5. Atypical- any other combination of abnormal tests. Results: Ages of chronic uraemic ranged from 22-76 years (Mean+_SD= 41.1+_15.02) and ages of controls ranged from 24-26 years (Mean+_SD =38.74_+12.13). Chronic uraemic groups comprised of 25 males and 5 females whereas the control group consisted of 17 males and 2 females. Age, BMI and resting pulse rate matched in both the groups whereas systolic and diastolic blood pressures were significantly higher in uraemics. Duration of dialysis in uraemics ranged from 1 month to 24 months. Several symptoms e.g., poastutal dizziness, palpitation, diarrhea, constipation, gustatory, early satiety, postprandial bloating, heart burn and dysphagia were noted in the uraemics. All the uraemics had one of the symptoms of automic neuropathy irrespective of the presence of absence of autonomic neuropathy as established by cardiovascular reflex testing. Twenty-five of the 30 uraemics had some evidence of autonomic neuropathy and prevalence of 83.33% was observed. Valsalva ratio, heart rate change during deep breathing and after standing were abnormal in 53.33%. 56.67% and 56.67% of uraemics respectively. Definite and severe involvement of autonomic nervous system was observed in 30% and 23.4% of uraemics respectively whereas 16.6% did not have any abnormal tests. No statistically significant association was observed between abnormal autonomic testing and duration of uraemic symptoms and duration of dialysis. Results off all the three heart rate tests were significantly lower in uraemics with autonomic dysfunction than in those without autonomic dysfunction when completed to the controls. Valsalva ratio and heart rate response to deep breathing were significantly low in ueraemics of> 35 year age group compared to 16-35 year age group. None of the controls had evidence of autonomic neuropathy. Conclusion: Involvement of autonomic nervous system in 83.3% of nondiabetic chronic uraemics in this study, in accordance with the results of other study. indicates that damage to cardiovascular autonomic reflexes is widespread in patients with CRF. Valsalva ration, heart rate response to deep breathing and standing were abnormal in 53.33%, 56.67% and 56.67% respectively whereas systolic BP fall to standing was seen only in 30%. Heart rate tests indicating cardiac vagal abnormalities are more striking than BP tests indicating peripheral sympathetic involvement in chronic uraemics. One or the other symptoms suggestive of autonomic neuropathy was present in all the chronic uraemics irrespective of the presence or absence of objective autonomic dysfunction. This shows that clinical symptomatology of sutonomic dysfunction is often nonspecific and reliance on only subjective symptoms is often inaccurate. All the heart rate test were significantly low in> 35 year age group than 16-35 years old controls. Chronic uraemics of > 35 years age group showed significantly decreased Valsalva ratio compared to 16-35 years age group. This shows that parasympathetic responses deteriorate with age. When both controls and chronic uraemics of 16-35 years age and > 35 year group were compared., the parasympathetic tests (heart rate tests) were still significantly lower in uraemics showing that there is residual effect of uraemia on parasympathetic nervous system. | ||
| 546 | |a Eng. | ||
| 650 | |a Autonomic nervous. |9 1626 | ||
| 650 | |a Dysfunction. |9 1627 | ||
| 650 | |a Haemodialysis. |9 1628 | ||
| 856 | |u http://nhrc.gov.np/contact/ |y Visit NHRC Library | ||
| 942 | |2 NLM |c TR | ||