Abstract
INTRODUCTION:
 This study was conducted to explore cardiovascular autonomic neuropathy and its pattern in chronic kidney disease patients.
 METHODS:
 Autonomic function using five standard tests was examined in 20 diabetic patients with CKD, 20 age and sex matched diabetic patients without CKD and 20 age and sex matched controls. Analysis of difference between the autonomic function was done in the three groups using Chi-square test or Fischer's test.
 RESULTS:
 Total 20 (100%) diabetic CKD patients were found to have autonomic neuropathy. Of these, 2 (10%) patients had early parasympathetic damage, 8 (40%) patients had definite parasympathetic damage, and 10 (50%) patients had combined damage. Heart rate response to standing was statistically significant (p = 0.014) among diabetic CKD patients when compared with diabetic patients without CKD. Combined form of autonomicdysfunction was more frequent in advanced stages of diabetic CKD. Three (42.85%) patients in stage 3 CKD, 4 (66.66%) patients in stage 4 CKD and 5 (71.42%) patients in stage 5 CKD, had combined autonomic failure.
 CONCLUSIONS:
 Autonomic neuropathy is common in native Nepalese diabetic CKD patients. Heart rate response to standing is significantly abnormal in diabetic CKD patients in comparison with diabetes mellitus patient without CKD. Severity of autonomic dysfunction increases with severity of CKD..
 KEYWORDS: cardiovascualr autonomic neuropathy, chronic kidney disease, diabetes mellitus.
Highlights
This study was conducted to explore cardiovascular autonomic neuropathy and its pattern in chronic kidney disease patients
Cardiovascular morbidity and mortality is common in chronic kidney disease patients and may be explained in part by abnormalities in cardiovascular autonomic regulation
Mean of the autonomic function score was found to be higher in patients with Chronic kidney disease (CKD) (p
Summary
This study was conducted to explore cardiovascular autonomic neuropathy and its pattern in chronic kidney disease patients. Chronic kidney disease (CKD) is a worldwide public health problem. Cardiovascular morbidity and mortality is common in chronic kidney disease patients and may be explained in part by abnormalities in cardiovascular autonomic regulation. Abnormalities may be amenable to intervention to prevent progression and premature cardiovascular morbidity and mortality. Dysfunction of both the parasympathetic and sympathetic nervous system has been observed in chronic renal failure (CRF) patients. Some studies report normal sympathetic dysfunction in patients of CRF while others contradict the presence of such abnormality in this group of patients.[2] This study explores the autonomic nervous dysfunction in patients of chronic kidney disease
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