Autonomic modulation with mindfulness-based stress reduction in chronic kidney disease: a randomized controlled trial

Area of Science:

• Nephrology
• Cardiology
• Psychology

Background:

• Chronic kidney disease (CKD) is linked to sympathetic nervous system (SNS) overactivation, increasing cardiovascular disease risk.
• Understanding interventions to modulate SNS activity in CKD is crucial for patient outcomes.

Purpose of the Study:

• To investigate the impact of an 8-week Mindfulness-Based Stress Reduction (MBSR) program on SNS activity in patients with CKD stages III-IV.
• To compare the effects of MBSR against an active control, the Health Enhancement Program (HEP).

Main Methods:

• A randomized controlled trial involving 29 CKD patients (stages III-IV).
• Participants were assigned to either MBSR or HEP groups.
• Muscle sympathetic nerve activity (MSNA) was measured using microneurography at rest and during stress maneuvers (mental arithmetic, handgrip, cold pressor test) before and after the 8-week intervention.

Main Results:

• A significant interaction between group and time was observed for MSNA reactivity during mental stress (P=0.029).
• MBSR significantly reduced MSNA reactivity to mental arithmetic post-intervention (P<0.001), with a large effect size (g=-0.858).
• Reduced MSNA reactivity was also noted during handgrip exercise in the MBSR group, while resting MSNA and responses to cold pressor test remained unchanged in both groups.

Conclusions:

• Eight weeks of MBSR effectively reduced sympathetic nervous system reactivity to mental stress and handgrip exercise in CKD patients.
• Mindfulness training is a feasible intervention that may offer clinical benefits for autonomic dysfunction in CKD.
• MBSR demonstrates potential as a therapeutic strategy to mitigate cardiovascular risk associated with SNS overactivation in CKD.