CARDIOVASCULAR DYSAUTONOMIA OF PATIENTS WITH END-STAGE RENAL-DISEASE AND TYPE-I OR TYPE-II DIABETES

Background: End-stage renal disease and diabetes mellitus are known to cause autonomic dysfunctions that are responsible for poor outcomes. Studies suggest that 24-hour heart rate variability with power spectra l analysis is more sensitive to early changes in autonomic function th an laboratory-evoked measures. Objectives: To evaluate cardiovascular autonomic function in patients (a) awaiting kidney or pancreas-kidney transplantation, (b) without diabetes (NonDM), (c) with Type I insulin dependent diabetes mellitus (IDDM), and (d) with Type II noninsulin d ependent diabetes mellitus (NIDDM), and lo compare the results of the laboratory-evoked cardiovascular autonomic tests with those from 24-ho ur heart rate variability monitoring with power spectral analysis. Met hod: This cross-sectional study examined autonomic function in prekidn ey transplant patients with and without diabetes (N = 96), comparing l aboratory-evoked measures lo 24-hour measures. Results: The nondiabeti c group had a normal change in heart rate with deep breathing, Valsalv a ratio, and change in systolic blood pressure with tilt. Both diabeti c groups had poorer values for all measures of heart rate variability; demonstrated abnormal changes in heart rate with deep breathing and b orderline Valsalva ratios; demonstrated a greater decrease in circadia n rhythmicity; and had lower SDNNS, pNN50s, and rMSSDs than the nondia betic group. Conclusions: Results showed that 24-hour measures are mor e sensitive, that patients with end-stage renal disease and diabetes r egardless of type experience significantly poorer function than do pat ients without diabetes, and that these values approach those associate d with sudden cardiac death.