Influence of continuous ambulatory peritoneal dialysis on the autonomic nervous system

The stabilization of systemic blood pressure is one of the most challenging tasks in the management of uremic patients. Continuous ambulatory peritoneal dialysis (CAPD) is associated with the development of hypotension in some patients [1–3]. Several pathogenetic mechanisms may be responsible for this type of dialysis-associated hypotension. Several authors have reported on the presence of autonomic dysfunction in uremic patients [4–8], and it has been postulated as a cause of hemodialysis-induced hypotension [4–8].However, Marquez-Julio et al [3] have suggested that hypotension in CAPD patients may be due to the combined effect of an increased removal of sodium chloride and water and the loss of large concentrations of vasoconstrictive substances.In recent years, CAPD has been performed in a rapidly increasing number of diabetic patients with endstage renal disease [9]. It is well known that autonomic neuropathy is a long-term complication of diabetes mellitus [10–12].The present study was undertaken first, to clarify whether or not hypotension in nondiabetic and diabetic CAPD patients is related to autonomic neuropathy and second, to see whether or not a functional lesion of the autonomic nervous system may be induced by peritoneal dialysis “per se”