Sahin Mesut, Kayatas Mansur, Urun Yuksel, Sennaroglu Engin, Akdur Saadet
Ankara Numune Hospital, Internal Medicine Clinic 4, Ankara, Turkey.
Ren Fail. 2006;28(5):383-7. doi: 10.1080/08860220600683722.
Autonomic neuropathy is an important cause of morbidity and mortality in patients with chronic renal failure (CRF) on hemodialysis. Generally, cardiovascular reflex tests are used to determine autonomic neuropathy. Our purpose in this study was to determine the frequency of autonomic neuropathy in patients with CRF on hemodialysis by using cardiovascular reflex tests and compare the sensitivity of each test.
The authors performed five tests: heart rate response to the Valsalva maneuver, heart rate variation during deep breathing, heart rate response to standing up, blood pressure response to standing up, and blood pressure response to hand grip exercise in order to determine autonomic neuropathy. Each test subject was evaluated as normal, borderline, and abnormal and scored as 0, 1, and 2, respectively. Subjects with a total score > or = 5 were considered to have autonomic neuropathy. Forty subjects with CRF on hemodialysis were included in this study. None of the subjects had diabetes mellitus or any other etiology that could cause autonomic neuropathy.
Thirty-five of 40 subjects (87.5%) had abnormal autonomic tests. In 35 subjects, the relationship between autonomic neuropathy and biochemical parameters, effects of treatment with vitamin D and erythropoietin, and urea reduction rate were studied. No relationship was found between autonomic neuropathy and age, time on hemodialysis, urea reduction rate, albumin, ferritin, calcium, inorganic phosphorus, intact parathyroid hormone, hemoglobin levels, and treatment with vitamin D and erythropoietin. The abnormal test results were as follows: 20 subjects (50%) in the heart rate response to the Valsalva Maneuver, 31 (77.5%) in the heart rate variation during deep breathing, 28 (70%) in the heart rate response to standing up, 6 (15%) in the blood pressure response to standing up, and 31 subjects (77.5%) in the blood pressure response to hand grip exercise tests. Among these five tests, the two most abnormal tests were the heart rate variation during deep breathing and the blood pressure response to hand grip exercise.
Patients with CRF on hemodialysis frequently have autonomic neuropathy. For the diagnosis and follow-up of patients, five cardiovascular autonomic reflex tests are generally used. In this study, it was determined that performing only one test instead of all five tests has a high sensitivity and is more practicable in terms of determining autonomic neuropathy.
自主神经病变是慢性肾衰竭（CRF）血液透析患者发病和死亡的重要原因。一般来说，心血管反射测试用于确定自主神经病变。本研究的目的是通过心血管反射测试确定CRF血液透析患者自主神经病变的发生率，并比较每项测试的敏感性。
作者进行了五项测试：Valsalva动作时的心率反应、深呼吸时的心率变异性、站立时的心率反应、站立时的血压反应以及握力运动时的血压反应，以确定自主神经病变。每个测试对象被评估为正常、临界和异常，并分别评分为0、1和2。总分≥5分的受试者被认为患有自主神经病变。本研究纳入了40例CRF血液透析患者。所有受试者均无糖尿病或任何其他可能导致自主神经病变的病因。
40例受试者中有35例（87.5%）自主神经测试异常。对35例受试者研究了自主神经病变与生化参数的关系、维生素D和促红细胞生成素治疗的效果以及尿素清除率。未发现自主神经病变与年龄、血液透析时间、尿素清除率、白蛋白、铁蛋白、钙、无机磷、完整甲状旁腺激素、血红蛋白水平以及维生素D和促红细胞生成素治疗之间存在关联。异常测试结果如下：Valsalva动作时的心率反应异常20例（50%），深呼吸时的心率变异性异常31例（77.5%），站立时的心率反应异常28例（70%），站立时的血压反应异常6例（15%），握力运动测试时的血压反应异常31例（77.5%）。在这五项测试中，异常最明显的两项测试是深呼吸时的心率变异性和握力运动时的血压反应。
CRF血液透析患者常伴有自主神经病变。对于患者的诊断和随访，一般采用五项心血管自主神经反射测试。本研究确定，仅进行一项测试而非所有五项测试在确定自主神经病变方面具有较高的敏感性且更具实用性。
