A Study of Cardiac Autonomic Neuropathy among Non-Diabetic Chronic Kidney Disease Patients

Document Type : Original Article


The Departments of Internal Medicine & Nephrology* and Cardiology**, Faculty of Medicine, Ain Shams University


Abstract Background: The primary etiologies of morbidity and death in people with chronic renal disease are cardiovascular consequences. Having cardiovascular autonomic neuropathy increases your chance of dying suddenly from heart failure. Aim of Study: To assess the CAN pattern in non-diabetic chronic kidney disease (CKD) who are not receiving dialysis. Patients and Methods: Fifty non-diabetic, non-dialysis CKD patients participated in this case-control study and were split into two groups: 25 with CKD in stages 3 and 4 made up Group I, 25 with CKD stage 5 made up Group II, in addition to 25 healthy volunteers as a control group. Full history and clinical examination with stress on autonomic neuropathy manifestations, routine laboratories and resting echocardiog-raphy were done. The heart rate reaction to the Valsalva ratio, the heart rate fluctuation during deep breathing, and the heart rate response to the standing 30:15 ratio test. Results: Cardiovascular autonomic neuropathy dysfunc-tions were significantly different in CKD patients (n=50) in comparison to the control group (MCp< 0.001). 29 had cardiac autonomic dysfunctions, the pattern that was detected in Group I was: 5 early parasympathetic, 4 definitive parasym-pathetic, 2 combined damage, 1 sympathetic damage. In Group II : 8 early parasympathetic, 6 definitive parasympathetic, and 3 combined damage. Patients with abnormal heart rate (R-R interval) variation during the deep breathing (beat/min) test had higher serum creatinine and lower serum calcium levels (FP=0.02). Conclusion: Cardiac autonomic dysfunction is common in non-diabetic, non-dialysisCKD without significant associ-ation with the occurrence of autonomic neuropathy clinical symptoms.