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Updated: Jun 14, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Sympathetic activity in chronic kidney disease patients is related to left ventricular mass despite antihypertensive
Laima Siddiqi1, Niek H Prakken, Birgitta K Velthuis
1Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands.
Insights
Chronic kidney disease patients show increased left ventricular mass despite controlled blood pressure. Muscle sympathetic nerve activity predicts this cardiac damage, suggesting additional sympatholytic therapy may be beneficial.
Area of Science:
- Nephrology
- Cardiology
- Hypertension
Background:
- Chronic kidney disease (CKD) is associated with sympathetic hyperactivity, contributing to hypertension and cardiovascular damage.
- Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) can reduce sympathetic activity.
- The relationship between sympathetic activity and organ damage in CKD requires further investigation.
Purpose of the Study:
- To compare left ventricular mass (LVM) in CKD patients treated with ACEi or ARBs versus controls.
- To determine if muscle sympathetic nerve activity (MSNA) and blood pressure predict increased LVM in CKD patients.
Main Methods:
- Restudied 20 CKD patients and 30 age-matched healthy controls.
- Quantified MSNA using microneurography.
- Measured LVM using contrast-free magnetic resonance imaging (MRI).
Main Results:
- CKD patients exhibited significantly greater LVM, LVM index, and mean wall thickness than controls (P < 0.01).
- MSNA was positively correlated with LVM (r=0.65), LVM index (r=0.46), and LV mean wall thickness (r=0.84) (P < 0.03).
- These associations persisted despite guideline-adherent ACEi/ARB treatment and controlled blood pressure.
Conclusions:
- CKD patients have increased LVM compared to controls, even with controlled blood pressure.
- Pre-existing MSNA predicts increased LVM in CKD patients, independent of standard antihypertensive treatment.
- Additional sympatholytic therapy may be beneficial for managing cardiovascular organ damage in CKD.
Background:
Chronic kidney disease (CKD) patients often have sympathetic hyperactivity, which contributes to the pathogenesis of hypertension and cardiovascular organ damage. Angiotensin-converting enzyme (ACE) inhibitors (ACEi) and angiotensin II receptor blockers (ARB) reduce sympathetic hyperactivity. Ideally, treatment should eliminate the relation between sympathetic activity and organ damage. The aim of the present study is firstly to compare left ventricular mass (LVM) of CKD patients using chronic ACEi or an ARB with LVM of controls. Secondly, we determine whether previously found muscle sympathetic nerve activity (MSNA) and arterial blood pressure during follow-up are predictive for the presence of increased LVM. Methods. We restudied 20 CKD patients and 30 healthy volunteers matched for age. Sympathetic nerve activity was quantified by the microneurography (MSNA). Arterial blood pressure was the mean of office blood pressure measurements. LVM was quantified by magnetic resonance imaging (MRI) without contrast.
Results:
The period between MSNA and MRI measurements was 9 ± 3 years. All patients were treated according to guidelines with an ACEi or an ARB. In CKD patients, mean systolic and diastolic arterial pressure were 129 ± 10 and 84 ± 5 mmHg, respectively, during follow-up. In patients, as compared to controls, LVM was 93 ± 16 versus 76 ± 18 g, LVM index 30 ± 5 versus 24 ± 4 g/m(2.7) and mean wall thickness 11 ± 2 versus 9.0 ± 1 mm (all P < 0.01). Moreover, MSNA was related to LVM (r = 0.65, P < 0.002), LVM index (r = 0.46, P < 0.03) and LV mean wall thickness (r = 0.84, P < 0.001). Conclusions. In conclusion, the present study demonstrates that measures of LVM in CKD patients are greater than in healthy controls, despite a well-controlled blood pressure in the patients. Moreover, there is a positive relationship between these measures of LVM and MSNA, assessed years before, despite a standard antihypertensive treatment. These results support the notion that additional sympatholytic therapy could be beneficial.
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