Differential distribution of muscle and skin sympathetic nerve activity in patients with end-stage renal disease

Park, Jeanie; Campese, Vito M.; Nobakht, Niloofar; Middlekauff, Holly R.

doi:10.1152/japplphysiol.90849.2008

Cited by 52 publications

(42 citation statements)

References 32 publications

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“…Indeed, in favor of the heterogeneous behavior of the sympathetic activation between various cardiovascular districts stands the observation that, in renal failure, although MSNA is markedly increased, skin sympathetic nerve traffic is almost normal. 24,25 This phenomenon, however, does not appear to be specific for chronic renal failure, with a similar behavior of the adrenergic neural function being detectable in hypertension, heart failure, obesity, metabolic syndrome, and hepatic cirrhosis as well. 26 -28 Our study was not designed to clarify the mechanisms responsible for the adrenergic overdrive seen in the renal failure state of a mild-to-moderate degree.…”

Section: Discussionmentioning

confidence: 99%

Early Sympathetic Activation in the Initial Clinical Stages of Chronic Renal Failure

et al. 2011

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Abstract-Direct and indirect indices of neuroadrenergic function have shown that end-stage renal disease is characterized by a marked sympathetic overdrive. It is unknown, however, whether this phenomenon represents a peculiar feature of end-stage renal disease or whether it is also detectable in the early clinical phases of the disease. The study has been performed in 73 hypertensive patients, of which there were 42 (age: 60.7Ϯ1.8 years, meanϮSEM) with a stable moderate chronic renal failure (mean estimated glomerular filtration rate: 40.7 mL/min per 1.73 m 2 , MDRD formula) and 31 age-matched controls with a preserved renal function. Measurements included anthropometric variables, sphygmomanometric and beat-to-beat blood pressure, heart rate (ECG), venous plasma norepinephrine (highperformance liquid chromatography), and efferent postganglionic muscle sympathetic nerve activity (microneurography, peroneal nerve). For similar anthropometric and hemodynamic values, renal failure patients displayed muscle sympathetic nerve activity values significantly and markedly greater than controls (60.0Ϯ2.1 versus 45.7Ϯ2.0 bursts per 100 heartbeats; PϽ0.001). Muscle sympathetic nerve activity showed a progressive and significant increase from the first to the fourth quartile of the estimated glomerular filtration rate values (first: 41.0Ϯ2.7; second: 51.9Ϯ1.7; third: 59.8Ϯ3.0; fourth: 61.9Ϯ3.3 bursts per 100 heartbeats), the statistical significance (PϽ0.05) between groups being maintained after adjustment for confounders. In the population as a whole, muscle sympathetic nerve activity was significantly and inversely correlated with the estimated glomerular filtration rate (rϭϪ0.59; PϽ0.0001). Thus, adrenergic activation is a phenomenon not confined to advanced renal failure but already detectable in the initial phases of the disease. The sympathetic overdrive parallels the severity of the renal failure, state and, thus, it might participate, in conjunction with other factors, at the disease progression. (Hypertension. 2011;57:846-851.) Key Words: chronic renal failure Ⅲ microneurography Ⅲ sympathetic nervous system A dvanced renal failure is accompanied by a marked activation of sympathetic cardiovascular influences, as documented by the increase in the circulating plasma levels of norepinephrine, the elevated number of sympathetic neural bursts recorded in the peroneal nerve via the microneurographic technique, and the augmented oscillations in the high-frequency band of the heart rate power spectra. [1][2][3][4][5][6][7][8][9][10][11][12][13] Whether the sympathetic activation also characterizes the earlier clinical phases of the renal failure state is not clear, however. This is because in the few studies performed so far in patients with mild renal disease, the population sample was small, and the plasma levels of norepinephrine showed inconsistent changes. 11,12 Furthermore, in the 2 previously published studies that assessed sympathetic nerve traffic via microneurography, approximately half of the patients evaluated ...

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Section: Discussionmentioning

confidence: 99%

Early Sympathetic Activation in the Initial Clinical Stages of Chronic Renal Failure

et al. 2011

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“…These observations were substantiated further by evidence from human studies showi n g e n h a n c e d d e p r e s s o r r e s p o n s e s t o c e n t r a l sympathoinhibition by clonidine [47] or debrisoquine [46] and animal models of CKD showing a pronounced hypotensive effect in response to ganglionic blockade [11,48]. In addition to elevated catecholamine levels, SNA levels in muscle [9, 12••, 31, 37, 49••, 50], but not skin [50], assessed clinically using microneurography, also are elevated, independent of resting BP [40] or circulating uremia-related toxins [45•, 51]. Further evidence of altered sympathetic activity in CKD patients has come from reports showing abnormal BP responses to standing or to a handgrip exercise [52], as well as augmented low-frequency (LF) oscillations of systolic blood pressure variability (SBPV), suggesting increased sympathetic vasomotor tone [53].…”

Section: Altered Autonomic Control Of Cardiovascular Function 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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“…Sympathetic overactivity (11)(12)(13)(14)(15)(16) and elevated ADMA (23)(24)(25) are prevalent disturbances in patients with CKD well before the stage where dialysis is needed, but the link between these two risk factors has never been investigated in patients at early and intermediate stages of CKD. In this study, we document for the first time an independent association between MSNA and circulating ADMA in patients with stage 2 to 4 CKD.…”

Section: Discussionmentioning

confidence: 99%

“…Respiration rate was monitored by a strain gauge pneumograph positioned at the mid-chest level. Multiunit recordings of efferent postganglionic sympathetic nerve activity to skeletal muscle (MSNA, expressed as burst frequency over time, i.e., number of bursts per minute) were obtained through a tungsten microelectrode inserted into the right or left peroneal nerve, as described (11)(12)(13)(14)(15)(16). Microneurographic, echocardiographic (see below), as well as other measurements were standardized in the two recruiting centers.…”

Section: Methodsmentioning

confidence: 99%

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Sympathetic Nerve Traffic and Asymmetric Dimethylarginine in Chronic Kidney Disease

Grassı

Seravalle

Ghiadoni

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Sympathetic overactivity and high levels of the endogenous inhibitor of NO synthase asymmetric dimethylarginine (ADMA) are prevalent risk factors in chronic kidney disease (CKD).Design, setting, participants, & measurements In 48 stage 2 to 4 CKD patients, we investigated the relationship between efferent postganglionic muscle sympathetic nerve traffic (microneurography) and circulating ADMA and analyzed the links between these risk factors and estimated GFR (eGFR), proteinuria, and different parameters of left ventricular (LV) geometry.Results CKD patients characterized by sympathetic nerve traffic values in the third tertile showed the highest ADMA levels, and this association was paralleled by a continuous, positive relationship between these two risk factors (r ϭ 0.32, P ϭ 0.03) independent of other confounders. Both sympathetic nerve traffic and ADMA were inversely related to eGFR and directly to proteinuria and LV geometry. Remarkably, the variance of eGFR, proteinuria, and LV geometry explained by sympathetic nerve traffic and ADMA largely overlapped because sympathetic nerve traffic but not ADMA was retained as a significant correlate of the eGFR (P Ͻ 0.001) and of the relative wall thickness or the left ventricular mass index/LV volume ratio (P ϭ 0.05) in models including both risk factors. ADMA, but not sympathetic nerve traffic, emerged as an independent correlate of proteinuria (P ϭ 0.003) in a model including the same covariates.Conclusions Sympathetic activity and ADMA may share a pathway leading to renal disease progression, proteinuria, and LV concentric remodeling in CKD patients.

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Differential distribution of muscle and skin sympathetic nerve activity in patients with end-stage renal disease

Abstract: Park J, Campese VM, Nobakht N, Middlekauff HR. Differential distribution of muscle and skin sympathetic nerve activity in patients with end-stage renal disease.

Cited by 52 publications

References 32 publications

Early Sympathetic Activation in the Initial Clinical Stages of Chronic Renal Failure

Early Sympathetic Activation in the Initial Clinical Stages of Chronic Renal Failure

Cardiovascular Autonomic Dysfunction in Chronic Kidney Disease: a Comprehensive Review

Sympathetic Nerve Traffic and Asymmetric Dimethylarginine in Chronic Kidney Disease

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