Sympathetic Vasomotor Response Of The Radial Artery In Patients With End Stage Renal Disease

Background: A novel way to assess the autonomic vascular functional unit of the upper extremity is the sympathetic vasomotor response of the radial artery using continuous wave Doppler ultrasonography. We used this method to determine whether such response is impaired in patients with end stage renal disease (ESRD). Methods: 43 patients with ESRD on renal replacement therapy(Ga), 48 normal healthy subjects(Gc1) and 28 patients with diabetes mellitus and/or hypertension, serum creatinine levels <1.13mg/dL (100μmol/l) and with no evidence of nephropathy(Gc2) underwent continuous wave Doppler examination of the radial artery before and after cough using Bidop ES-100V3® (8MHz probe). The maximal change in waveform after cough was recorded. The resistance index was calculated as systolic velocity minus diastolic velocity/systolic velocity. The pulsatility index was calculated as peak to peak change/mean flow velocity. Results: The resistance index after cough as a ratio of the baseline (RI) in Gc1 increased significantly (0.21±0.19) as opposed to Ga (0.02±0.07), the mean difference between the two groups being 1.93±0.29 (CI: 1.36,2.51 p<0.001). The pulsatility index after cough as a ratio of the baseline (PI) in the Gc1 increased significantly (1.93±2.09) as opposed to Ga (0.36±0.56), the mean difference between the two groups being 1.56 SD 0.31 (CI: 0.94,2.19 p<0.001). There was no significant difference in RI and PI between Ga and Gc2. Conclusion: Patients with ESRD have impaired sympathetic vasomotor response of the radial artery after cough.