Autonomic neuropathy predisposing to arrhythmias in hemodialysis patients

Arrhythmias are frequent among the dialysis population and can cause symptoms of palpitations or dizziness. Since autonomic disturbances are known to cause an increased arrhythmogenic stimulus, we questioned whether the presence of central autonomic neuropathy increased the frequency of arrhythmias as identified by 24-hour electrocardiographic monitoring 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 duration on dialysis was 17.0 months (range, 1 to 175 months). Four patients had diabetes. Each patient was tested for autonomic control of blood pressure and heart rate, and underwent Holter electrocardiographic monitoring, commencing 30 minutes before dialysis, for a 24-hour period. The tapes were then analyzed for ventricular and atrial rhythm changes. There was a significantly increased incidence of arrhythmias in individuals with abnormal blood pressure responses (P = 0.005), heart rate responses (P = 0.01), and combined blood pressure and heart rate responses (P = 0.004). We conclude that patients with autonomic dysfunction had an increased frequency of arrhythmias during dialysis.