Cause and Consequences of Sympathetic Hyperactivity in Chronic Kidney Disease

Kotanko, Peter

doi:10.1159/000089444

Cited by 34 publications

(24 citation statements)

References 46 publications

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“…Recent evidence also suggests that tonic arterial chemoreceptor activation is involved in sympathetic overactivity of CKD, because deactivation of the arterial chemoreceptors by inhalation of 100 % O 2 noticeably reduces muscle SNA in patients with renal failure [78]. Various mechanisms that impair the oxygen-carrying capacity of blood and therefore sensitize the carotid bodies have been suggested with respect to chemoreceptor-induced activation of SNA, including sleep apnea, metabolic acidosis [79], and anemia associated with chronic renal failure [45•].…”

Section: Altered Reflex Control Mechanisms Of Autonomic Outflows In Ckdmentioning

confidence: 99%

Cardiovascular Autonomic Dysfunction in Chronic Kidney Disease: a Comprehensive Review

Salman

2015

Curr Hypertens Rep

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Cardiovascular autonomic dysfunction is a major complication of chronic kidney disease (CKD), likely contributing to the high incidence of cardiovascular mortality in this patient population. In addition to adrenergic overdrive in affected individuals, clinical and experimental evidence now strongly indicates the presence of impaired reflex control of both sympathetic and parasympathetic outflow to the heart and vasculature. Although the principal underlying mechanisms are not completely understood, potential involvements of altered baroreceptor, cardiopulmonary, and chemoreceptor reflex function, along with factors including but not limited to increased renin-angiotensin-aldosterone system activity, activation of the renal afferents and cardiovascular structural remodeling have been suggested. This review therefore analyzes potential mechanisms underpinning autonomic imbalance in CKD, covers results accumulated thus far on cardiovascular autonomic function studies in clinical and experimental renal failure, discusses the role of current interventional and therapeutic strategies in ameliorating autonomic deficits associated with chronic renal dysfunction, and identifies gaps in our knowledge of neural mechanisms driving cardiovascular disease in CKD.

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Section: Altered Reflex Control Mechanisms Of Autonomic Outflows In Ckdmentioning

confidence: 99%

Cardiovascular Autonomic Dysfunction in Chronic Kidney Disease: a Comprehensive Review

Salman

2015

Curr Hypertens Rep

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“…In addition to pre-existing HTN, non-adherence to salt restriction, intradialytic sodium gain due to dialysate sodium concentration exceeding serum levels, inappropriate sodium profiling, and intradialytic administration of saline are associated with the high prevalence of HTN in HD patients. High BP may be further aggravated by increased sympathetic activity, the cause of which is multifactorial [4]. There is no generally accepted definition of HTN in HD patients [5].…”

Section: Introductionmentioning

confidence: 99%

Early Systolic Blood Pressure Changes in Incident Hemodialysis Patients Are Associated with Mortality in the First Year

Sipahioğlu

Usvyat

Liu

et al. 2012

Kidney Blood Press Res

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Background: In incident hemodialysis (HD) patients, the relationship between early systolic blood pressure (SBP) dynamics and mortality is unknown. Methods: Baseline SBP levels were stratified into 5 categories ranging from <120 and ≥180 mm Hg. Early pre-HD SBP change was defined as the slope of pre-HD SBP from week 1 to 12 and categorized in quartiles (Q1, lowest slope). SBP slopes were computed for each patient by simple linear regression. Results: In 3,446 incident HD patients (42% females, 44% black, age 62 ± 15 years), the median pre-HD SBP slope was –1.7 (Q1) to +2.3 (Q4) mm Hg/week. In an adjusted multivariate Cox regression analysis, patients with declining SBP (slope Q1) had higher mortality compared to patients with increasing pre-HD SBP (slope Q4) at 12 months (hazard ratio 2.01, 95% confidence interval 1.35–3.01). In addition, patients with baseline pre-HD SBP <120 mm Hg showed higher mortality compared to the reference group (SBP ≥180 mm Hg) at 12 months (hazard ratio 1.89, 95% confidence interval 1.03–3.45). Conclusion: Baseline pre-HD SBP and early SBP dynamics are associated with mortality in the first year of dialysis. Patients who had low (pre-HD SBP <120 mm Hg) or declining SBP had the highest mortality rates. Particular attention is warranted in incident HD patients with low or declining SBP.

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“…We propose that this is related to an adequate insulin response to the dialysate glucose load, resulting in a blunted blood glucose rise and mitigated parasympathetic activation. Under most circumstances, HD activates the sympathetic system in response to ultrafiltration [31,32] . In addition to this 'classical' stimulus, a rise in insulin levels may stimulate the sympathetic nervous system [1] .…”

Section: Discussionmentioning

confidence: 99%

Effects of Dialysate Glucose Concentration on Heart Rate Variability in Chronic Hemodialysis Patients: Results of a Prospective Randomized Trial

Ferrario

Raimann

Thijssen

et al. 2011

Kidney Blood Press Res

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Background: Chronic hemodialysis (HD) patients suffer from an appallingly high cardiovascular mortality. During HD, patients are exposed to dialysate glucose, which may alter blood glucose levels and thus exert effects on the autonomic nervous system. Heart rate variability (HRV) is an established indicator of autonomic nervous system activity and a predictor of cardiovascular outcomes. This study investigated the effects of two commonly used dialysate glucose concentrations [100 mg/dl (HD100), and 200 mg/dl (HD200)] on HRV in chronic HD patients. Methods: In this prospective, randomized, controlled, single-masked, cross-over trial, subjects were randomized to receive HD100 or HD200 for a period of 3 weeks followed by a cross-over to the respective other dialysate (www.clinicaltrials.gov #NCT00618033). Blood glucose and insulin levels were measured before and after HD. Intradialytic Holter electrocardiograms were recorded and HRV time domain, frequency domain and complexity parameters analyzed. Results: Twenty-three HD patients (age 56 ± 12 years, 11 male, 14 black, 11 with diabetes) were studied. Diabetic subjects showed significantly higher serum glucose levels with HD200 as compared to HD100 (HD100: 146 ± 48 mg/dl; HD200: 192 ± 57 mg/dl; p < 0.01); this hyperglycemia was accompanied by an increase of the high-frequency band of HRV (p = 0.019), a reflection of increased parasympathetic activity. HRV did not change in nondiabetic subjects. Conclusion: In diabetic subjects, the use of HD200 increased vagal tone. Given the importance of sympathetic activation to counteract intradialytic hypotension, our findings support the use of HD100 in diabetic HD patients.

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Cause and Consequences of Sympathetic Hyperactivity in Chronic Kidney Disease

Cited by 34 publications

References 46 publications

Cardiovascular Autonomic Dysfunction in Chronic Kidney Disease: a Comprehensive Review

Cardiovascular Autonomic Dysfunction in Chronic Kidney Disease: a Comprehensive Review

Early Systolic Blood Pressure Changes in Incident Hemodialysis Patients Are Associated with Mortality in the First Year

Effects of Dialysate Glucose Concentration on Heart Rate Variability in Chronic Hemodialysis Patients: Results of a Prospective Randomized Trial

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