Uremic autonomic neuropathy: evaluation of ephedrine sulphate therapy for hemodialysis-induced hypotension.

The hemodynamic response to ephedrine sulphate were studied in a patient on maintenance hemodialysis therapy with chronic renal failure due to renal amyloidosis. The evaluation (including cardiac catheterization studies) and estimation of responses to Valsalva maneuvers before and after ephedrine administration documented the diagnosis of autonomic insufficiency. Oral ephedrine failed to influence the episodes of severe dialysis-induced hypotension. Also the patient did not benefit from the infusion of Aramine. These studies suggest that catecholamine stores of adrenergic nerves may be depleted in uremic patients with clinical signs of autonomic neuropathy.