Autonomic dysfunction in non-diabetic continuous ambulatory peritoneal dialysis patients as measured by sympathetic skin response

Abstract Objectives The purpose of this study was to evaluate the prevalence of autonomic dysfunction in non-diabetic continuous ambulatory peritoneal dialysis patients and to investigate its risk factors using the sympathetic skin response. Methods We performed a cross-sectional study on 113 non-diabetic continuous ambulatory peritoneal dialysis patients using the sympathetic skin response, a non-invasive test to detect sympathetic sudomotor deficit. Results Sixty-six patients (58.4%) showed an abnormal sympathetic skin response suggesting a sympathetic sudomotor deficit. Patients were then categorized into two groups according to their sympathetic skin response result. The baseline clinical data, nutritional and dialysis adequacy indices of the two groups were compared. Patients with an abnormal sympathetic skin response are significantly older (54.9 ± 12.52 vs 61.79 ± 12.16 years, p=0.004), more malnourished with a lower albumin (35.79 ± 2.41 vs 33.98 ± 4.92 g/L, p=0.012) and normalized protein nitrogen appearance values (0.99 ± 0.17 vs 0.93 ± 0.16 g/kg/day, p=0.046). Further, they have a lower residual renal function as calculated by weekly renal Kt/V (0.63 ± 0.61 vs 0.29 ± 0.35, p=0.001) or renal creatinine clearance (41.35 ± 40.2 vs 21.96 ± 27.22 L/wk/1.73 m 2 , p=0.006). Patients with an abnormal sympathetic skin response are also receiving a smaller dialysis dose as calculated by the total weekly Kt/V (2.13 ± 0.6 vs 1.83 ± 0.41, p=0.004) or the total creatinine clearance (82. 42 ± 37.34 vs 66.81 ± 25.38 L/wk/1.73 m 2 , p=0.017). Conclusion Based on sympathetic skin response, autonomic dysfunction is common among non-diabetic continuous ambulatory peritoneal dialysis patients. Patients with autonomic dysfunction are significantly older, more malnourished, have low residual renal function and are receiving a smaller dialysis dose. A prospective study is warranted to investigate the reversibility of autonomic dysfunction after an increment in dialysis dose.