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Sympathetic nervous system function and dysfunction in chronic hemodialysis patients

Dvora Rubinger1, Rebecca Backenroth, Dan Sapoznikov

  • 1Nephrology and Hypertension Services, Hadassah University, Medical Center, Jerusalem, Israel. rdvora@hadassah.org.il

Seminars in Dialysis
|May 1, 2013
PubMed

Insights

Sympathetic nervous system overactivity is common in hemodialysis (HD) patients, contributing to hypertension and cardiovascular issues. Targeting this overactivity may improve outcomes for HD patients.

Area of Science:

  • Nephrology
  • Cardiovascular Physiology
  • Autonomic Neuroscience

Background:

  • Adequate sympathetic nervous system (SNS) activation is crucial for blood pressure regulation during hemodialysis (HD).
  • Chronic SNS overactivity in HD patients is linked to hypertension and cardiovascular disease.
  • Understanding SNS activity is key to managing cardiovascular risks in HD.

Purpose of the Study:

  • To review recent findings on SNS activity in hemodialysis patients.
  • To explore the role of SNS overactivity in intradialytic complications and long-term cardiovascular health.
  • To discuss potential therapeutic strategies targeting SNS overactivity.

Main Methods:

  • Review of recent literature on SNS activity in chronic renal disease and HD patients.
  • Assessment of SNS activity through direct (muscle sympathetic nerve activity - MSNA) and indirect methods (heart rate variability, blood pressure variability, baroreflex function).
  • Analysis of SNS response during HD procedures, intradialytic hypotension/hypertension, and post-renal transplantation.

Main Results:

  • SNS overactivity is prevalent in HD patients, often assessed indirectly via decreased heart rate variability (HRV) and impaired baroreflex function.
  • HD procedures and ultrafiltration enhance sympathetic activity and baroreflex responses.
  • SNS overactivity is implicated in intradialytic hypertensive episodes and refractory hypertension, persisting even after renal transplantation.

Conclusions:

  • Decreased HRV and baroreflex function in HD patients are associated with increased mortality and morbidity.
  • Persistent sympathetic overactivity, even post-transplant, highlights the need for targeted interventions.
  • Therapeutic strategies including optimized HD, pharmacotherapy, and renal sympathetic denervation show promise for improving cardiovascular outcomes.

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