Autonomic neuropathy in hemodialysis patients: questionnaires versus clinical tests.
OBJECTIVE
Uremic neuropathy (UN) is a typical complication of long-term dialysis therapy and may manifest as distal, symmetric, and both senso-motoric and autonomic nerve dysfunction. Its clinical picture is highly variable and it is not known how the symptoms of UN reported by chronic dialysis patients correspond to positive results of clinical tests for autonomic dysfunction. The objective of this study was to compare the prevalence of self-reported symptoms of autonomic neuropathy (AN) revealed in patient questionnaires with the prevalence of findings from objective clinical tests.


METHODS
The study group included 45 patients (26 males, 19 females), mean age 60 +/- 15.5 years, on chronic hemodialysis for 7.8 +/- 2.6 years. In all subjects, blood pressure (BPci) and heart rate (HRci) variability indexes (calculated as BP and HR during Ewing and Clarke' tests divided by HR and BP at rest) were measured using the Finapres which records beat-to-beat blood pressure and heart rate. Additionally, patients completed seven-question questionnaires which assessed the presence of most typical AN symptoms. The control group comprised 12 healthy subjects (age 52 +/- 19.5 years).


RESULTS
The results from the questionnaires showed that falls of BP occurred in 73% of patients, itching of skin in 42%, constipation or diarrhea in 33%, filling of stomach in 25%, and decreased sweating in 17%. Altogether 85.9% of patients reported one or more subjective symptoms of neuropathy. In contrast, modified Ewing and Clarke's test revealed that only 17.7% of participants demonstrated overt pathologies. Neither blood pressure nor heart rate changeability indexes in patients and healthy subjects showed significant differences with the exception of intense inhalation and static effort.


CONCLUSIONS
Our results show much higher frequency of subjective symptoms of AN in chronic dialysis patients than objective symptoms detected with clinical tests.
Nowicki
Michał
M
Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Łódź, University Hospital #1, Kopcińskiego 22, 90-153, Lodz, Poland. nefro@wp.pl.
Zwiech
Rafał
R
Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Łódź, University Hospital #1, Kopcińskiego 22, 90-153, Lodz, Poland.
Dryja
Przemysław
P
Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Łódź, University Hospital #1, Kopcińskiego 22, 90-153, Lodz, Poland.
Sobański
Wiktor
W
Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Łódź, University Hospital #1, Kopcińskiego 22, 90-153, Lodz, Poland.
D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D001794:Blood Pressure; D005260:Female; D006339:Heart Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis; D011795:Surveys and Questionnaires; D014511:Uremia / Q000453:epidemiology / Q000628:therapy