Onodugo O D, Ulasi I I, Ijoma C K, Arodiwe E B, Okoye J U, Ezeala-Adikaibe B A, Onodugo N P, Ugwu E O
Department of Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria.
Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria.
Niger J Clin Pract. 2018 Jul;21(7):932-938. doi: 10.4103/njcp.njcp_369_17.
Chronic kidney disease (CKD) is a global public health problem with increasing incidence and mortality in Africa. Autonomic dysfunction (AD) has been implicated as a major contributor to the disease morbidity and mortality, but little is known about the predictors of this dysfunction in African populations. Understanding the predictors of this condition is necessary for early detection and management of CKDs. Objectives: This study was designed to determine the predictors of AD in CKD patients in Nigeria.
It was a cross-sectional study of CKD patients at University of Nigeria Teaching Hospital, Enugu, Nigeria. The CKD patients with AD were compared with those without AD and a normal control group. Autonomic function was assessed through noninvasive cardiovascular tests: measurement of resting tachycardia, orthostatic hypotension, heart rate response (HRR) to standing, HRR to Valsalva maneuvre, and HRR to respiration. Data on symptoms of CKD and AD were obtained using a validated questionnaire.
The mean age of the CKD patients was 41.3 ± 1.5 (range: 21-69) years. Early hospital presentation is associated with significantly less risk of the development of AD (P < 0.001). Dizziness, nocturnal diarrhea, and impotence are the major markers/predictors of AD in CKD patients (P < 0.05).
AD is common among predialysis CKD patients in Nigeria, and best predicted by the presence of postural dizziness, nocturnal diarrhea, and impotence in men. Physicians should, therefore, be on the lookout for these features for prompt and adequate management of cases.
慢性肾脏病（CKD）是一个全球性的公共卫生问题，在非洲其发病率和死亡率不断上升。自主神经功能障碍（AD）被认为是导致该疾病发病和死亡的主要因素，但对于非洲人群中这种功能障碍的预测因素知之甚少。了解这种情况的预测因素对于CKD的早期检测和管理至关重要。目的：本研究旨在确定尼日利亚CKD患者中AD的预测因素。
这是一项对尼日利亚埃努古大学教学医院的CKD患者进行的横断面研究。将患有AD的CKD患者与未患AD的患者以及正常对照组进行比较。通过非侵入性心血管测试评估自主神经功能：静息心动过速测量、直立性低血压、站立时心率反应（HRR）、瓦尔萨尔瓦动作时HRR以及呼吸时HRR。使用经过验证的问卷获取有关CKD和AD症状的数据。
CKD患者的平均年龄为41.3±1.5（范围：21 - 69）岁。早期住院与AD发生风险显著降低相关（P < 0.001）。头晕、夜间腹泻和阳痿是CKD患者中AD的主要标志物/预测因素（P < 0.05）。
AD在尼日利亚透析前CKD患者中很常见，男性出现姿势性头晕、夜间腹泻和阳痿最能预测AD。因此，医生应留意这些特征，以便对病例进行及时和充分的管理。
