Abstract
BackgroundEnd-stage renal disease frequently leads to increased cardiovascular mortality. Cardiovascular autonomic neuropathy (CAN) may be predictive of cardiac arrhythmias and sudden cardiac death in patients with end-stage renal disease.MethodsA total of 70 patients with end-stage renal disease were included in the study. The assessment of cardiac dysautonomia was based on the four standardized tests performed at the baseline and, again, at the end of the study. The criteria for CAN included at least two abnormal test results.ResultsFifty of 70 patients completed the study and were followed-up after one year. Out of the 50 patients, 44 (88%) had CAN at baseline. Twelve (24%) patients died at the one-year follow-up. Sudden cardiac death was reported in seven out of 12 (58%) patients. All seven patients who died had high dysautonomia scores (three abnormal tests) at the baseline. There was a significantly higher percentage of patients with all four abnormal tests amongst patients who died of any cause (56% vs. 17%; RR 6.07, 95% CI 1.29-28.49; p-value 0.02) or due to sudden cardiac death (43% vs. 10.5%; RR 6.37, 95% CI 1.03-39.36; p-value 0.04). All five patients who did not have CAN at the baseline developed this abnormality on repeat testing after one year.ConclusionThe prevalence of CAN in patients with end-stage renal disease on maintenance hemodialysis was significantly higher. CAN was an independent predictor of all-cause and cardiovascular mortality, which highlights it as a risk stratification tool in patients with end-stage renal disease.
Highlights
Chronic kidney disease (CKD) is associated with high morbidity and mortality throughout the continuum from early disease to advanced stages requiring dialysis
There was a significantly higher percentage of patients with all four abnormal tests amongst patients who died of any cause (56% vs. 17%; RR 6.07, 95% confidence interval (CI) 1.29-28.49; p-value 0.02) or due to sudden cardiac death (43% vs. 10.5%; RR 6.37, 95% CI 1.03-39.36; p-value 0.04)
Cardiovascular autonomic neuropathy (CAN)-related morbidity and mortality have been researched in other diseases, including familial dysautonomia [15], Ehlers-Danlos syndrome [16], chronic obstructive pulmonary disease [17], liver cirrhosis [18], hypertension and hyperuricemia [19]
Summary
Chronic kidney disease (CKD) is associated with high morbidity and mortality throughout the continuum from early disease to advanced stages requiring dialysis. Patients with CKD demonstrate a predilection to die prematurely, which has largely been attributed to the death from cardiovascular (CV) disease. Increased CV and all-cause mortality in patients with CKD have become an interesting topic that merits investigation [1]. How to cite this article Bokhari S A, Inayat F, Jawa A, et al (August 31, 2018) Cardiovascular Autonomic Neuropathy and its Association with Cardiovascular and Allcause Mortality in Patients with End-stage Renal Disease. End-stage renal disease frequently leads to increased cardiovascular mortality. Cardiovascular autonomic neuropathy (CAN) may be predictive of cardiac arrhythmias and sudden cardiac death in patients with endstage renal disease
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
