Study of Autonomic Neuropathy in Cardiovascular System in Chronic Renal Failure Patients on Maintenance Hemodialysis

Abstract

Autonomic nervous system abnormalities are major causes of morbidity and mortality in patients with chronic renal failure (CRF) on hemodialysis and are generally considered a part of polyneuropathy. Postural hypotension, impotency, gastrointestinal disturbance, gastrointestinal motility, and sweating abnormalities are common symptoms. The most frequent complication in patients with CRF on hemodialysis is intradialytic hypotension, and it has been suggested that intradialytic hypotension is mostly related to autonomic neuropathy. The pathogenesis of autonomic neuropathy is unclear, but a reduced response to norepinephrine by the end organ and the toxic effect of metabolic toxins are considered to be some of the causes. Five cardiovascular reflex tests are generally used to determine autonomic neuropathy: the heart rate reaction to the Valsalva Maneuver, the heart rate variability during deep breathing, the heart rate response to standing up, the blood pressure response to standing up, and the blood pressure response to hand grip exercise.