1. Total number of patient with cardiac dysautonomia
Cardiac Dysautonomia in Patients with End Stage Renal Disease on Hemodialysis 
Hafiz I. Ahmad MD, FASN*1, Arif Asif MD, FASN3, Syed Rizwan Bokhari MD1,
Muhammad Zaman Khan Assir MBBS2, Muhammad Awais MBBS1 and Sabin Nasir MBBS1.
1- Department of Nephrology and 2Department of Medicine, Allama Iqbal Medical College / Jinnah Hospital, Lahore, Pakistan;
3Division of Nephrology, University of Miami School of Medicine, Miami, FL, United States.
Background
Sudden cardiac death is common in chronic hemodialysis patients. Cardiac dysautonomia (dysfunction of cardiac autonomic nervous system) has been shown to be associated with increased frequency of cardiac arrhythmias and may be the cause of higher incidence of sudden cardiac death.
Clinical tests conducted to assess cardiac dysautonomia
Heart rate response to deep breathing
Valsalva Ratio
30:15 ratio of R-R interval measured at beats 15 and 30 after an upright position
Total number of patient with cardiac dysautonomia
44 (88%)
Abnormal heart rate response to deep breathing (E:I ratio of less than 1.17)
47 (94%)
Abnormal Valsalva Ratio (longest to shortest R-R ratio of less than 1.2)
45 (90%)
Abnormal 30:15 Ratio (30th to 15th R-R ratio on standing less than 1.03)
34 (68%)
Methods
In this observational analysis, we studied the frequency of cardiac dysautonomia in our dialysis population. Seventy hemodialysis patients were enrolled in this study. Three tests to assess the status of cardiac autonomic dysfunction were performed. Twenty patients were excluded because of the inability to perform Valsalva maneuver. Based on previous studies, presence of at least 2 abnormal tests was considered to be positive for cardiac dysautonomia.
Total number of patients included in the study 70
Number of patient who completed the study 50
Males
52%
Diabetics
32%
Mean Age
43.9 years
Conclusion
This study finds a high incidence of cardiac dysautonomia in chronic hemodialysis patients. Future studies should be conducted to confirm these findings and investigate the association between cardiac dysautonomia and sudden cardiac death.
Number of abnormal tests in cardiac dysautonomia patients
3 abnormal tests in 32 patients (64%)
2 abnormal tests in 12 patients (24%)
1 abnormal test in 5 patients (10%)
Results
Fifty patients completed the tests successfully. 26 were male (52%), 32% were diabetic and the mean age was 43.9 years. Forty four (88%) were found to have cardiac dysautonomia. Abnormal heart rate response to deep breathing (E:I ratio less than 1.17) was found in 47 patients (94%), abnormal
Valsalva ratio (longest to shortest R-R ratio less than 1.2) in 45 patients (90%), abnormal 30:15 ratio (30th to 15th R-R ratio on standing less than 1.03) in 34 patients (68%). We found 3 abnormal tests in 32 patients (64%), 2 abnormal tests in 12 patients (24%), 1 abnormal test in 5 patients (10%) and no abnormal test in 1 patient (2%). Overall, 44 (88%) of the patients had cardiac dysautonomia.