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Am J Physiol Regul Integr Comp Physiol. 2008 Oct;295(4):R1188-94. doi: 10.1152/ajpregu.90473.2008. Epub 2008 Aug 06.

Exercise pressor reflex in humans with end-stage renal disease.

American journal of physiology. Regulatory, integrative and comparative physiology

Jeanie Park, Vito M Campese, Holly R Middlekauff

Affiliations

  1. Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. [email protected]

PMID: 18685067 PMCID: PMC2576092 DOI: 10.1152/ajpregu.90473.2008

Abstract

Previous work has suggested that end-stage renal disease (ESRD) patients may have an exaggerated sympathetic nervous system (SNS) response during exercise. We hypothesized that ESRD patients have an exaggerated blood pressure (BP) response during moderate static handgrip exercise (SHG 30%) and that the exaggerated BP response is mediated by SNS overactivation, characterized by augmented mechanoreceptor activation and blunted metaboreceptor control, as has been described in other chronic diseases. We measured hemodynamics and muscle sympathetic nerve activity (MSNA) in 13 ESRD and 16 controls during: 1) passive hand movement (PHM; mechanoreceptor isolation); 2) low-level rhythmic handgrip exercise (RHG 20%; central command and mechanoreceptor activation); 3) SHG 30%, followed by posthandgrip circulatory arrest (PHGCA; metaboreceptor activation); and 4) cold pressor test (CPT; nonexercise stimulus). ESRD patients had exaggerated increases in systolic BP during SHG 30%; however, the absolute and relative increase in MSNA was not augmented, excluding SNS overactivation as the cause of the exaggerated BP response. Increase in MSNA was not exaggerated during RHG 20% and PHM, demonstrating that mechanoreceptor activation is not heightened in ESRD. During PHGCA, MSNA remained elevated in controls but decreased rapidly to baseline levels in ESRD, indicative of markedly blunted metaboreceptor control of MSNA. MSNA response to CPT was virtually identical in ESRD and controls, excluding a generalized sympathetic hyporeactivity in ESRD. In conclusion, ESRD patients have an exaggerated increase in SBP during SHG 30% that is not mediated by overactivation of the SNS directed to muscle. SBP responses were also exaggerated during mechanoreceptor activation and metaboreceptor activation, but without concomitant augmentation in MSNA responses. Metaboreceptor control of MSNA was blunted in ESRD, but the overall ability to mount a SNS response was not impaired. Other mechanisms besides SNS overactivation, such as impaired vasodilatation, should be explored to explain the exaggerated exercise pressor reflex in ESRD.

References

  1. Am J Physiol Heart Circ Physiol. 2003 Sep;285(3):H974-82 - PubMed
  2. Am J Physiol Regul Integr Comp Physiol. 2001 Apr;280(4):R1240-8 - PubMed
  3. Am J Physiol Heart Circ Physiol. 2004 Nov;287(5):H1937-43 - PubMed
  4. Arch Intern Med. 1989 Feb;149(2):433-6 - PubMed
  5. Kidney Int. 1993 Apr;43(4):885-92 - PubMed
  6. J Am Soc Nephrol. 1996 Aug;7(8):1223-7 - PubMed
  7. Kidney Int. 2002 Nov;62(5):1870-4 - PubMed
  8. Kidney Int. 1984 Jul;26(1):66-71 - PubMed
  9. Am J Physiol Heart Circ Physiol. 2001 Aug;281(2):H469-75 - PubMed
  10. J Appl Physiol (1985). 2005 Jul;99(1):5-22 - PubMed
  11. Acta Physiol Scand. 1972 Jan;84(1):82-94 - PubMed
  12. Kidney Int. 1987 Dec;32(6):877-83 - PubMed
  13. Acta Physiol Scand. 1972 Jan;84(1):65-81 - PubMed
  14. Annu Rev Physiol. 1988;50:565-76 - PubMed
  15. Clin Neurophysiol. 2006 Nov;117(11):2357-84 - PubMed
  16. Am J Med. 2003 Sep;115(4):291-7 - PubMed
  17. J Clin Invest. 1996 May 1;97(9):2092-100 - PubMed
  18. J Hypertens. 2006 May;24(5):881-7 - PubMed
  19. Exerc Sport Sci Rev. 1991;19:313-49 - PubMed
  20. Physiol Rev. 1979 Oct;59(4):919-57 - PubMed
  21. Clin Auton Res. 2002 Dec;12(6):429-39 - PubMed
  22. Circulation. 2003 Feb 11;107(5):675-8 - PubMed
  23. J Clin Invest. 1993 Feb;91(2):420-4 - PubMed
  24. J Appl Physiol (1985). 2001 May;90(5):1714-9 - PubMed
  25. Circulation. 1991 Nov;84(5):2034-9 - PubMed
  26. Circ Res. 1985 Sep;57(3):461-9 - PubMed
  27. Am J Hypertens. 2006 Sep;19(9):951-7 - PubMed
  28. Am J Physiol Renal Physiol. 2006 Apr;290(4):F753-61 - PubMed
  29. Kidney Int. 2002 Nov;62(5):1901-13 - PubMed
  30. Nephrol Dial Transplant. 1994;9(11):1600-5 - PubMed
  31. Hypertension. 1987 May;9(5):429-36 - PubMed
  32. J Hum Hypertens. 2001 May;15(5):353-6 - PubMed
  33. J Appl Physiol (1985). 1994 Mar;76(3):1077-81 - PubMed
  34. Circ Res. 1995 Jan;76(1):127-31 - PubMed
  35. J Physiol. 1992;453:45-58 - PubMed
  36. Heart Fail Rev. 2000 Mar;5(1):87-100 - PubMed
  37. J Physiol. 1996 Mar 15;491 ( Pt 3):881-7 - PubMed

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