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Autonomic Neuropathy-Reply

Autonomic Neuropathy-Reply Abstract In Reply. —I agree completely that few prior studies have been able to demonstrate that autonomic insufficiency is of major clinical importance as a cause of dialysis hypotension. Perhaps the best study in this regard is by Lilley et al.1 Recently, my colleagues and I prospectively studied 12 dialysis patients, comparing acetate and bicarbonate dialysate from a hemodynamic viewpoint. We tested the patients with Valsalva's maneuver, hand grip, and amyl nitrite tests before entry, and found that seven patients had detectable autonomic dysfunction and five patients had normal autonomic dysfunction. In the studies that followed2 we were only able to show a difference in the two groups when acetate dialysate and a dialysate sodium concentration of 130 mEq/L were used. This difference was manifested only in the area of orthostatic BP response after dialysis. Thus, our study suggests autonomic dysfunction may play a contributing role to dialysis hypotension, References 1. Lilley JJ, Golden J, Stone RA: Adrenergic regulation of blood pressure in chronic renal failure. J Clin Invest 1976;57:1190-1200.Crossref 2. Velez R, Woodard T, Henrich WL: Hemodynamic comparison of acetate v bicarbonate hemodialysis: Results in patients with and without autonomic insufficiency, abstracted. Clin Res 1982;30:883. 3. Henrich WL, Katz FH, Molinoff PB, et al: Competitive effects of hypokalemia and volume depletion on plasma renin activity, aldosterone and catecholamine concentrations in hemodialysis patients. Kidney Int 1977;12:279-284.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Autonomic Neuropathy-Reply

Archives of Internal Medicine , Volume 143 (8) – Aug 1, 1983

Autonomic Neuropathy-Reply

Abstract

Abstract In Reply. —I agree completely that few prior studies have been able to demonstrate that autonomic insufficiency is of major clinical importance as a cause of dialysis hypotension. Perhaps the best study in this regard is by Lilley et al.1 Recently, my colleagues and I prospectively studied 12 dialysis patients, comparing acetate and bicarbonate dialysate from a hemodynamic viewpoint. We tested the patients with Valsalva's maneuver, hand grip, and amyl nitrite tests before...
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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1983.00350080157045
Publisher site
See Article on Publisher Site

Abstract

Abstract In Reply. —I agree completely that few prior studies have been able to demonstrate that autonomic insufficiency is of major clinical importance as a cause of dialysis hypotension. Perhaps the best study in this regard is by Lilley et al.1 Recently, my colleagues and I prospectively studied 12 dialysis patients, comparing acetate and bicarbonate dialysate from a hemodynamic viewpoint. We tested the patients with Valsalva's maneuver, hand grip, and amyl nitrite tests before entry, and found that seven patients had detectable autonomic dysfunction and five patients had normal autonomic dysfunction. In the studies that followed2 we were only able to show a difference in the two groups when acetate dialysate and a dialysate sodium concentration of 130 mEq/L were used. This difference was manifested only in the area of orthostatic BP response after dialysis. Thus, our study suggests autonomic dysfunction may play a contributing role to dialysis hypotension, References 1. Lilley JJ, Golden J, Stone RA: Adrenergic regulation of blood pressure in chronic renal failure. J Clin Invest 1976;57:1190-1200.Crossref 2. Velez R, Woodard T, Henrich WL: Hemodynamic comparison of acetate v bicarbonate hemodialysis: Results in patients with and without autonomic insufficiency, abstracted. Clin Res 1982;30:883. 3. Henrich WL, Katz FH, Molinoff PB, et al: Competitive effects of hypokalemia and volume depletion on plasma renin activity, aldosterone and catecholamine concentrations in hemodialysis patients. Kidney Int 1977;12:279-284.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 1, 1983

References