Understanding the associations between haemodynamic instability and autonomic function may allow early identification of chronic kidney disease patients likely to benefit from individualized dialysis therapy.
May aid early cardiovascular risk stratification in CKD; leaves open whether targeting baroreflex sensitivity improves outcomes.
PURPOSE OF REVIEW: Autonomic dysfunction is well recognized in chronic kidney disease. The baroreflex arc is an important component of the autonomic nervous system and influences vasodilatation and heart rate in response to information derived from baroreceptors located in the aorta and common carotid arteries. Appropriate regulation of systemic blood pressure is therefore dependent upon the integrity and normal function of the baroreflex arc. Vasomotor instability during haemodialysis has traditionally been identified as a pathophysiological state largely due to the failure of compensatory mechanisms during ultrafiltration. This review article discusses autonomic dysfunction as a key factor contributing to the systemic haemodynamic instability that may occur during dialysis. RECENT FINDINGS: Relationships have begun to be established between markers of reduced baroreflex sensitivity and abnormal cardiovascular structure, such as left ventricular dysfunction, left ventricular hypertrophy and arterial stiffness. SUMMARY: Pathological relationships between cardiovascular structure and function remain important in the understanding of both haemodynamic instability and cardiovascular mortality in chronic kidney disease patients. Understanding the associations between conventional markers of haemodynamic instability and autonomic function will allow early identification of patients likely to benefit from individualizing dialysis therapy.
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Chesterton et al. (2005) studied this question.
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