title: Association between cardiovascular autonomic neuropathy and left ventricular hypertrophy in diabetic haemodialysis patients.
abstract: BACKGROUND
  Patients with diabetic nephropathy are likely to have neurological complications including cardiovascular autonomic dysfunction, which is related to increased risk of mortality. We investigated whether cardiovascular autonomic neuropathy is associated with left ventricular hypertrophy (LVH) in diabetic haemodialysis patients.
  
  
  METHODS
  Holter electrocardiography was carried out for 24 h with time and frequency domain analyses of heart rate variability in 154 diabetic (age 62+/-11 years) and 63 non-diabetic haemodialysis patients (62+/-10 years). The left ventricular mass index (LVMI) was determined by echocardiography. We used the percentage of differences exceeding 50 ms between adjacent normal RR intervals (pNN50) in time domain analysis and the power in the high-frequency range (HF: 0.15-0.40 Hz) in frequency domain analysis as indicators of parasympathetic activity.
  
  
  RESULTS
  The mean LVMI was greater in diabetic than in non-diabetic patients (168+/-63 vs 144+/-54 g/m(2), P<0.01). LVMI inversely correlated with pNN50 (r = -0.270, P = 0.0007, n = 154) and HF (r = -0.277, P = 0.0005, n = 154) in diabetic patients, but not in non-diabetic patients. By multiple logistic analysis, LVH was strongly associated with pNN50 (odds ratio 0.088; 0, <2%; 1, >/=2%) and HF (odds ratio 0.058; 0, <500 ms(2); 1, >/=500 ms(2)) in diabetic patients.
  
  
  CONCLUSIONS
  Impaired parasympathetic activity, which indicates cardiovascular autonomic neuropathy, was associated with the presence of LVH in diabetic haemodialysis patients. The co-existence of cardiovascular autonomic neuropathy and LVH may be one of the key factors for the high incidence of cardiovascular events in diabetic haemodialysis patients.
authors.affiliation: Cardiovascular Division, Toujinkai Hospital, 16 Negoro, Momoyama-cho, Fushimi-ku, Kyoto 612-8024, Japan. tojinkai.hosp@dream.com
authors.forename: Masato
authors.initials: M
authors.lastname: Nishimura
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Toyofumi
authors.initials: T
authors.lastname: Fukuda
authors.forename: Koji
authors.initials: K
authors.lastname: Okino
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Naoto
authors.initials: N
authors.lastname: Nakamura
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Hakuo
authors.initials: H
authors.lastname: Takahashi
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Ono
mesh_terms: D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000503:physiopathology; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002319:Cardiovascular System / Q000294:innervation*; D003920:Diabetes Mellitus / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000150:complications* / Q000628:therapy; D003929:Diabetic Neuropathies / Q000150:complications* / Q000503:physiopathology; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010275:Parasympathetic Nervous System / Q000503:physiopathology; D006435:Renal Dialysis