The hemodynamic and humoral responses to tilting in diabetic patients on chronic hemodialysis treatment.

Hemodynamic and humoral responses to tilting were examined in order to elucidate the autonomic nervous function in diabetic hemodialysis patients. Eleven diabetic (DM) and eleven non-diabetic (non-DM) patients on maintenance hemodialysis treatment were involved in the experimentation, matching the age and the duration of hemodialysis. Cardiac output, blood pressure, plasma renin activity (PRA), norepinephrine (NE) and epinephrine (EP) were measured before and 5 minutes after the 45 degree tilting. By the tilting the blood pressure significantly fell in DM, whereas it rose slightly but significantly in non-DM. In both groups, however, the heart rate remained unchanged, and either cardiac index or stroke volume index decreased equally. The percentile increase in total peripheral resistance index (TPRI) was significantly smaller in DM (14.6%) than in non-DM (27.9%). There was a significant correlation between the changes in TPRI and diastolic blood pressure (r = 0.730, p less than 0.01). NE and EP increased significantly in non-DM but not in DM. Blood pressure reduced by the tilting in DM was associated with a small or equivocal response in either TPRI or plasma NE. The heart rate did not respond to the tilting in both groups. These results indicate that both sympathetic and parasympathetic nervous systems are deranged in diabetic hemodialysis patients but parasympathetic dysfunction is evident even in non-diabetic hemodialysis patients.