AUTONOMIC NEUROPATHY PREDISPOSING TO ARRHYTHMIAS IN HEMODIALYSIS-PATIENTS

Arrhythmias are frequent among the dialysis population and can cause s ymptoms of palpitations or dizziness, Since autonomic disturbances are known to cause an increased arrhythmogenic stimulus, we questioned wh ether the presence of central autonomic neuropathy increased the frequ ency of arrhythmias as identified by 24-hour electrocardiographic moni toring in dialysis patients, Seventy-one patients were randomly chosen from patients established on dialysis in two centers, The mean age of the patients was 71.3 years (median age, 67 years) and median duratio n on dialysis was 17.0 months (range, 1 to 175 months). Four patients had diabetes, Each patient was tested for autonomic control of blood p ressure and heart rate, and underwent Holter electrocardiographic moni toring, commencing 30 minutes before dialysis, for a 24-hour period. T he tapes were then analyzed for ventricular and atrial rhythm changes, There was a significantly increased incidence of arrhythmias in indiv iduals with abnormal blood pressure responses (P = 0.005), heart rate responses (P = 0.01), and combined blood pressure and heart rate respo nses (P = 0.004), We conclude that patients with autonomic dysfunction had an increased frequency of arrhythmias during dialysis. (C) 1997 b y the National Kidney Foundation, Inc.