Prevalence and Factors associated with Autonomic Dysfunction in Continuous Ambulatory Peritoneal Dialysis Patients

Main Article Content

Nuttaya Wachiraphansakul
Kanyanutt Boonyatarp
Thanawat Vongchaiudomchoke

Abstract

Background: Chronic kidney disease patients are at risk for autonomic dysfunction (AD). Prevalence and associated factors of AD in patients with continuous ambulatory peritoneal dialysis (CAPD) are not clearly known.


Objective: To determine the prevalence and identify the associated factors of AD in CAPD patients.


Material and method: A prospective observational study was conducted among CKD patients who received CAPD at the Renal Unit, Lampang Hospital from August 2019 to January 2020. Testing for AD by observing
an EKG record of heart rate variability during deep breathing (HRVDB) in 1 minute was carried out. The comparison between the AD group and non-AD group was obtained by statistical analysis. The regression analysis was used to determine the associated factors of AD.


Results: A total of 130 CAPD patients were eligible and AD was found in 93 cases (71.5%). Diabetes and overweight were more commonly found in the AD group than the non-AD group (51.6% vs 27.0%, p=0.012 and 49.5% vs 21.6%, p=0.005, respectively). The AD group received diuretics (77.4% vs 56.8%, p=0.030) and beta-blockers (60.2% vs 32.4%, p=0.006) more than the non-AD group.The associated factors of AD by univariate analysis were overweight (OR 3.55, 95%CI 1.47-8.57, p=0.005), diabetes (OR 2.88, 95%CI 1.25-6.62, p=0.013), receiving beta blockers (OR 3.15, 95%CI 1.41-7.05, p=0.005) and receiving diuretics (OR 2.61, 95%CI 1.16-5.88, p=0.020). With the multivariate analysis, the associated factors of AD were overweight (OR 2.65, 95%CI 1.03-6.85, p=0.044) and diabetes (OR 2.42, 95%CI 1.01-5.84, p=0.049).


Conclusions: Prevalence of AD in CAPD patients was 71.5%. Overweight

Article Details

How to Cite
Wachiraphansakul, N., Boonyatarp, K., & Vongchaiudomchoke, T. (2020). Prevalence and Factors associated with Autonomic Dysfunction in Continuous Ambulatory Peritoneal Dialysis Patients. Lampang Medical Journal, 41(1), 9–17. Retrieved from https://he01.tci-thaijo.org/index.php/LMJ/article/view/241540
Section
Original Article

References

Krishnan AV, Kiernan MC. Neurological complications of chronic kidney disease. Nat Rev Neurol. 2009;5(10):542-51.

Arnold R, Issar T, Krishnan AV, Pussell BA. Neurological complications in chronic kidney disease. JRSM Cardiovasc Dis. 2016;5:2048004016677687.

Sidhu MS, Dellsperger KC. Cardiovascular problems in dialysis patients: impact on survival. Adv Perit Dial. 2010;26:47-52.

Genovesi S, Porcu L, Luise MC, Riva H, Nava E, Contaldo G, et al. Sudden death in end stage renal disease: comparing hemodialysis versus peritoneal dialysis. Blood Purif. 2017;44(1):77-88.

Agrawal A, Saran R, Khanna R. Management of orthostatic hypotension from autonomic dysfunction in diabetics on peritoneal dialysis. Perit Dial Int. 1999;19(5):415-7.

Jassal SV, Douglas JF, Stout RW. Prevalence of central autonomic neuropathy in elderly dialysis patients. Nephrol Dial Transplant. 1998;13(7):1702-8.

Polak G, Strozecki P, Grzesk G, Manitius J, Grabczewska Z, Przybyl R. Effect of parathormone on heart rate variability in hemodialysis patients. Auton Neurosci. 2004;115(1-2):94-8.

Spallone V, Ziegler D, Freeman R, Bernardi L, Frontoni S, Pop-Busui R, et al. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011;27(7):639-53.

Ussawawongaraya W, Spilles N, Nilwarangkoon S, Jariyapongskul A. The correlation of parathyroid hormone and heart rate variability in CAPD patients. J Med Assoc Thai. 2013;96(5):595-602.

Ussawawongaraya W, Woraratsoontorn P, Promprasit N, Spilles N, Cheewinsiriwat S, Bunlue chokchai C. Effect of obesity on cardiac autonomic nervous system of continuous ambulatory peritoneal dialysis patients. Journal of Applied Science. 2016;15:90-102.

Savica V, Musolino R, Di Leo R, Santoro D, Vita G, Bellinghieri G. Autonomic dysfunction in uremia. Am J Kidney Dis. 2001;38(4 Suppl 1):S118-21.

Gupta A, Jain G, Kaur M, Jaryal AK, Deepak KK, Bhowmik D, et al. Association of impaired baroreflex sensitivity and increased arterial stiffness in peritoneal dialysis patients. Clin Exp Nephrol. 2016;20(2):302-8.

Sahin M, Kayatas M, Urun Y, Sennaroglu E, Akdur S. Performing only one cardiovascular reflex test has a high positive predictive value for diagnosing autonomic neuropathy in patients with chronic renal failure on hemodialysis. Ren Fail. 2006;28(5):383-7.

Pei J, Tang W, Li LX, Su CY, Wang T. Heart rate variability predicts mortality in peritoneal dialysis patients. Ren Fail. 2015;37(7):1132-7.

Malik S, Winney RJ, Ewing DJ. Chronic renal failure and cardiovascular autonomic function. Nephron.

;43(3):191-5.

Mallamaci F, Zoccali C, Ciccarelli M, Briggs JD. Autonomic function in uremic patients treated by hemodialysis or CAPD and in transplant patients. Clin Nephrol. 1986;25(4):175-80.

Yung JC, Tsui YT, Wong CK, Cheng YL, Yu AWY. Autonomic dysfunction in non-diabetic continuous ambulatory peritoneal dialysis patients as measured by sympathetic skin response. Hong Kong Journal of Nephrology.

;5(1):34-9.

Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed). 1982;285(6346):916-8.

Drory VE, Korczyn AD. Sympathetic skin response: age effect. Neurology.1993;43:1818-20.

Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22Suppl 3:1-203.

Paolisso G, Manzella D, Montano N, Gambardella A, Varricchio M. Plasma leptin concentrations and cardiac autonomic nervous system in healthy subjects with different body weights. J Clin Endocrinol Metab. 2000;85(5):1810-4.

Emdin M, Gastaldelli A, Muscelli E, Macerata A, Natali A, Camastra S, et al. Hyperinsulinemia and autonomic nervous system dysfunction in obesity: effects of weight loss. Circulation. 2001;103(4):513-9.

Esler M, Straznicky N, Eikelis N, Masuo K, Lambert G, Lambert E. Mechanisms of sympathetic activation in obesity-related hypertension. Hypertension. 2006;48(5):787-96.

Smith MM, Minson CT. Obesity and adipokines: effects on sympathetic overactivity. J Physiol. 2012;590(8):1787-801.

Saxton SN, Withers SB, Heagerty AM. Emerging roles of sympathetic nerves and inflammation in perivascular adipose tissue. Cardiovasc Drugs Ther. 2019;33(2):245-59.