Sudoscan and Cardiovascular outcomes in Hemodialysis

Association of Electrochemical Skin Conductance by Sudoscan and Cardiovascular Outcomes
in Hemodialysis Patients

M Touzot et al. Kidney Int Rep (2022) 7, 2734–2736

Article reference:

We recently reported for the first time, the clinical pertinence of the Sudoscan to assess dysautonomia to predict intradialytic hypotension.

In a 24-month follow-up of the original cohort, we have now assessed the potential of Sudoscan
to predict cardiovascular events and overall mortality in a single cohort of Hemodialysis patients.

A total of 176 patients were included in the analysis. During the 24-month study, a first major adverse cardiovascular event (MACE) occurred in 41 patients that included 3 strokes, 4 acute myocardial infarctions, and 37 deaths.

Patients with MACE were older (73±12 vs. 62±14 years old, P < 0.001), with more diabetes mellitus (56 vs. 34%, P < 0.01), and had a higher rate of atrial fibrillation (34% vs. 14%, P < 0.01).
Mean predialysis foot ESC was significantly lower in patients with MACE, than those with no MACE (47±21 µS vs. 57±22 µS, P < 0.01). No difference in the mean predialysis hand ESC
(43±19 vs. 45±20 µS, P ¼ 0.34) were observed between these 2 groups.

HD patients with pathological foot ESC had a 3-fold increased risk of death
(hazard ratio [HR] = 3.74, 95% confidence interval [CI] 1.83– 7.63, P < 0.001). This association was confirmed with a multivariate Cox regression model. A pathological pre-HD foot ESC was also associated with an increased risk of death (HR = 2.92, 95% CI 1.36–6.26, P < 0.01). Similarly,
HD patients with pathological foot ESC had a 3- fold increased risk of MACE
(HR = 2.88, 95% CI 1.49–5.56, P < 0.01).

In conclusion, besides its capacity to predict intradialytic hypotension, the Sudoscan appears as a promising, simple, noninvasive, and quick test that can be used in routine to predict mortality and cardiac events in HD patients.

Cumulative incidence risk of death according to the presence of a pathological Foot ESC. The graph represents the cumulative incidence risk for death during the 24-month follow-up, according to the presence (red) or not (black) of a pathological foot ESC. HR, hazard ratio

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