Correlation of cardiac autonomic neuropathy in predialysis and dialysis chronic kidney disease patients
Dr. Harshitha NJ, Dr. Prakash Rao KS, Dr. Pooja Dadmi, Dr. Siddu BN
Background and Objectives: CKD is one of the major health problems all over the world.Autonomic dysfunction is common in CKD patients but symptomatic autonomic Neuropathy is not thatcommon. Presence of Cardiac Autonomic Neuropathy (CAN) is responsible for silent myocardial infarction and sudden death in CKD patients. Prolongation of corrected QT (QTc) in electrocardiogram (ECG), lack of heart rate variability (HRV) and postural hypotension (PH) are found to be early indicators of Cardiovascular Autonomic Neuropathy. Methods: This is a Cross-sectional study done to evaluate the correlation of cardiac autonomic neuropathy among chronic kidney disease patients in pre-dialysis stage and CKD patients in maintenance hemodialysis stage, with the help of prolongation of corrected QT (QTc) in ECG, lack of heart rate variability (HRV) and postural hypotension (PH). A total of 100 patients admitted in KVG Medical College, Sullia satisfying the inclusion and exclusion criteria were studied. They were divided into 2 groups, CKD in predialysis stage and CKD in maintenance hemodialysis stage. The prevalence of CAN was evaluated and compared in the two groups with respect to Heart rate variability, Postural hypotension and QTc interval. Results: Out of 100 CKD patients, 50 patients were CKD in predialysis stage and 50 patients were CKD on maintenance hemodialysis. Among the predialysis group, 15 patients (30%) had QTc prolongation, 27 patients (54%) had postural hypotension and 49 patients (98%) had lack of heart rate variability. Among the dialysis group, 28 patients (56%) had QTc prolangation, 39 patients (78%) had Postural hypotension and 50 patients (100%) had lack of heart rate variability. All these values were statistically significant suggesting prevalence of CAN increases as the progression of CKD from predialysis stage to hemodialysis stage. Conclusions: From the above results we can conclude that the Prevalence of Cardiovascular Autonomic Neuropathy is high in CKD patients and the prevalence of CAN increases as the progression of CKD from predialysis stage to dialysis stage. Hence we suggest all CKD patient should be evaluated with simple bedside tests like postural hypotension, lack of Heart rate variability (HRV), prolongation of QTc in ECG for early detection of CAN, so as to prevent further complications with early intervention and proactive treatment.