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Cardiac Dysautonomia in Patients with End Stage Renal Disease on Hemodialysis 

Cardiac Dysautonomia in Patients with End Stage Renal Disease on Hemodialysis . Hafiz I. Ahmad MD, FASN* 1 , Arif Asif MD, FASN 3 , Syed Rizwan Bokhari MD 1 , Muhammad Zaman Khan Assir MBBS 2 , Muhammad Awais MBBS 1 and Sabin Nasir MBBS 1 .

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Cardiac Dysautonomia in Patients with End Stage Renal Disease on Hemodialysis 

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  1. Cardiac Dysautonomia in Patients with End Stage Renal Disease on Hemodialysis  Hafiz I. Ahmad MD, FASN*1, Arif Asif MD, FASN3, Syed Rizwan Bokhari MD1, Muhammad Zaman Khan Assir MBBS2, Muhammad Awais MBBS1 and Sabin Nasir MBBS1. 1- Department of Nephrology and 2Department of Medicine, Allama Iqbal Medical College / Jinnah Hospital, Lahore, Pakistan; 3Division of Nephrology, University of Miami School of Medicine, Miami, FL, United States. Background Sudden cardiac death is common in chronic hemodialysis patients. Cardiac dysautonomia (dysfunction of cardiac autonomic nervous system) has been shown to be associated with increased frequency of cardiac arrhythmias and may be the cause of higher incidence of sudden cardiac death. Methods In this observational analysis, we studied the frequency of cardiac dysautonomia in our dialysis population. Seventy hemodialysis patients were enrolled in this study. Three tests to assess the status of cardiac autonomic dysfunction were performed. Twenty patients were excluded because of the inability to perform Valsalva maneuver. Based on previous studies, presence of at least 2 abnormal tests was considered to be positive for cardiac dysautonomia. Conclusion This study finds a high incidence of cardiac dysautonomia in chronic hemodialysis patients. Future studies should be conducted to confirm these findings and investigate the association between cardiac dysautonomia and sudden cardiac death. Results Fifty patients completed the tests successfully. 26 were male (52%), 32% were diabetic and the mean age was 43.9 years. Forty four (88%) were found to have cardiac dysautonomia. Abnormal heart rate response to deep breathing (E:I ratio less than 1.17) was found in 47 patients (94%), abnormal Valsalva ratio (longest to shortest R-R ratio less than 1.2) in 45 patients (90%), abnormal 30:15 ratio (30th to 15th R-R ratio on standing less than 1.03) in 34 patients (68%). We found 3 abnormal tests in 32 patients (64%), 2 abnormal tests in 12 patients (24%), 1 abnormal test in 5 patients (10%) and no abnormal test in 1 patient (2%). Overall, 44 (88%) of the patients had cardiac dysautonomia.

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