Dialysis – Transplantation
Kidney International (2003) 64, 1089–1094; doi:10.1046/j.1523-1755.2003.00174.x
High vibration perception threshold and autonomic dysfunction in hemodialysis patients with intradialysis hypotension
Po-Tsang Lee, Hua-Chang Fang, Chien-Liang Chen, Hsiao-Min Chung, Yee-Hsuan Chiou and Kang-Ju Chou
Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan; Institute of Clinical Medicine, National Cheng Kung University Medical College, Tainan, Taiwan
Correspondence: Kang-Ju Chou, M.D., Division of Nephrology, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd, Kaohsiung, Taiwan 813. E-mail: kjchou@isca.vghks.gov.tw
Received 14 August 2002; Revised 11 February 2003; Re-revised 8 April 2003; Accepted 5 May 2003.
Abstract
High vibration perception threshold and autonomic dysfunction in hemodialysis patients with intradialysis hypotension.
Background
Intradialysis hypotension is a common problem among hemodialysis patients. Some studies have shown that autonomic neuropathy could be a major cause of intradialysis hypotension, whereas others have not. Furthermore, whether there are parallel changes in the autonomic nervous system and somatic nerves remains unclear.
Methods
We investigated the autonomic and peripheral nervous functions of 12 chronic hemodialysis patients who suffered from intradialysis hypotension, and of 12 age- and sex-matched hemodialysis patients who had stable blood pressure during hemodialysis. We used spectral analysis of their heart rate variability and systemic vascular resistance to evaluate autonomic functions. Vibrameter and nerve conduction studies to assess peripheral nervous function were also performed. Low-frequency/high-frequency ratio power index was used as a surrogate of sympathovagal balance.
Results
The power index rose progressively in the control group and reached significantly high levels at hour 4 compared to the basal values (3.7 
0.5 vs. 2.1 0.3; P < 0.05). However in the group prone to hypotension, the power index remained almost unchanged. In addition, their systemic vascular resistance was lower than that in the control group (13.7 1.8 vs. 22.3 2.6 Wood units; P < 0.05). The vibration perception thresholds of the index finger and great toe were significantly higher in the group prone to hypotension (4.7 0.7 vs. 2.2 0.3 vibration units and 3.1 0.4 vs. 1.5 0.2 vibration units, respectively; both P < 0.05).
Conclusion
We found that more severe damage to autonomic and peripheral nervous system occurred in patients prone to hypotension.
Keywords:
uremia, hemodialysis, hypotension, heart rate variability, vibration perception threshold
