Abstract
BackgroundPatients with chronic kidney disease (CKD) who undergo chronic haemodialysis (HD) show altered sympathetic tone, which is related to a higher cardiovascular mortality. The purpose of this study was to investigate the effect of transition from pre-HD to HD on cardiac sympathetic innervation.MethodsEighteen patients aged 58 ± 18 years (mean ± standard deviation [SD]), 13 males and five females, with stage 5 CKD and nine healthy control subjects aged 52 ± 17 (mean ± SD), three males and six females, were included in this prospective study between May 2010 and December 2013. All patients underwent 123I-labelled meta-iodobenzylguanidine (123I-MIBG) scintigraphy for cardiac sympathetic innervation and electrocardiographically gated adenosine stress and rest 99mTc-labelled tetrofosmin single-photon emission computed tomography for myocardial perfusion imaging prior to (pre-HD) and 6 months after the start of HD. Results of 123I-MIBG scans in patients were compared to controls. Impaired cardiac sympathetic innervation was defined as late heart-to-mediastinum ratio (HMR) < 2.0.ResultsMean late HMR was lower in patients during HD (2.3) than in controls (2.9) (p = 0.035); however, in patients it did not differ between pre-HD and after the start of HD. During HD, two patients showed new sympathetic innervation abnormalities, and in three patients innervation abnormalities seemed to coincide with myocardial perfusion abnormalities.ConclusionsCKD patients show cardiac sympathetic innervation abnormalities, which do not seem to progress during the maintenance HD. The relationship between sympathetic innervation abnormalities and myocardial perfusion abnormalities in HD patients needs further exploration.
Highlights
Patients with chronic kidney disease (CKD) who undergo chronic haemodialysis (HD) show altered sympathetic tone, which is related to a higher cardiovascular mortality
An unknown number of individuals with CKD are completely asymptomatic for coronary artery disease (CAD)
Diagnosis of CKD was based on serum levels of creatinine, and subsequent estimated glomerular filtration rate, the latter determined by the Modification of Diet in Renal Disease method [12]
Summary
Patients with chronic kidney disease (CKD) who undergo chronic haemodialysis (HD) show altered sympathetic tone, which is related to a higher cardiovascular mortality. Cardiac ischaemia and autonomic dysfunction are reliable predictors for future cardiac events and are associated with increased long-term mortality [6–8]. The presence of these findings in CKD patients is related to a higher cardiovascular mortality, exceeding that of age- and gender-matched healthy control subjects [9]. CKD patients with concomitant diabetes show silent myocardial ischaemia and diabetic autonomic neuropathy Both the extent of cardiac ischaemia and sympathetic innervation abnormalities as well as the timepoint of their development during or even before starting HD are unclear. Autonomic dysfunction is commonly present in end-stage renal disease [11], but whether this results in lack of symptoms in cardiac ischaemia is unknown
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