Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul;48(7):300060520933797.
doi: 10.1177/0300060520933797.

Improved cardiovascular autonomic function and decreased protein-bound uremic toxins in patients with end-stage renal disease after peritoneal dialysis

Ben-Chung Cheng  1   2 , Yun-Ru Lai  1   3 , Chih-Cheng Huang  3 , Cheng-Hsien Lu  1   2   4   5
Affiliations

Improved cardiovascular autonomic function and decreased protein-bound uremic toxins in patients with end-stage renal disease after peritoneal dialysis

Ben-Chung Cheng et al. J Int Med Res. 2020 Jul.

Abstract

Objective: Cardiovascular autonomic neuropathy is highly prevalent in patients with end-stage renal disease (ESRD), and it has a high fatality rate. This study aimed to determine whether peritoneal dialysis (PD) improves cardiovascular autonomic function (CAF) and decreases protein-bound uremic toxin (indoxyl sulfate [IS], p-cresyl sulfate [PCS]) levels.

Methods: IS and PCS levels, and parameters of CAF (heart rate response to deep breathing [HR_DB], the Valsalva ratio, baroreflex sensitivity, and the frequency domain) were prospectively evaluated in 26 patients with ESRD undergoing PD at two time points (pre-PD and 6 months post-PD). For comparison, 19 consecutive patients with pre-dialysis chronic kidney disease and 30 age- and sex-matched healthy volunteers were included as the disease and control groups, respectively.

Results: Baroreflex sensitivity, HR_DB, and the Valsalva ratio were significantly lower in the ESRD and disease groups than in the control group. IS and PCS levels were significantly higher in the ESRD group than in the control group. Sympathetic/parasympathetic activity was improved after PD. IS levels were significantly decreased after PD and IS level changes were correlated with the frequency domain.

Conclusions: IS may play a role in cardiovascular autonomic neuropathy, and decreased IS levels after dialysis are associated with sympathetic/parasympathetic activity imbalance.

Keywords: Cardiovascular autonomic function; end-stage renal disease; indoxyl sulfate; p-cresyl sulfate; peritoneal dialysis; protein-bound uremic toxin.

PubMed Disclaimer

References

    1. Robinson TG, Carr SJ. Cardiovascular autonomic dysfunction in uremia. Kidney Int 2002; 62: 1921–1932. - PubMed
    1. Fukuta H, Hayano J, Ishihara S, et al. Prognostic value of heart rate variability in patients with end‐stage renal disease on chronic haemodialysis. Nephrol Dial Transplant 2003; 18: 318–325. - PubMed
    1. Doulgerakis D, Moyssakis I, Kapelios CJ, et al. Cardiac autonomic neuropathy predicts all-cause and cardiovascular mortality in patients with end-stage renal failure: a 5-year prospective study. Kidney Int Rep 2017; 2: 686–694. - PMC - PubMed
    1. Ewing DJ, Martyn CN, Young RJ, et al. The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care 1985; 8: 491–498. - PubMed
    1. Koomans HA, Blankestijn PJ, Joles JA. Sympathetic hyperactivity in chronic renal failure: a wake-up call. J Am Soc Nephrol 2004; 15: 524–537. - PubMed