title: Renal transplantation normalizes baroreflex sensitivity through improvement in central arterial stiffness.
abstract: BACKGROUND
  In end-stage renal disease (ESRD) patients, the most common cause of mortality and morbidity are cardiovascular events. This could be attributed to the impaired baroreflex function observed in this group of patients. The effect of renal transplantation (RT) on the baroreflex sensitivity (BRS) in ESRD patients has been inadequately addressed. Therefore, we investigated baroreflex function and its relation to arterial stiffness indices and cardiovascular variability parameters (heart rate and blood pressure variability--HRV and BPV) in ESRD patients before and after transplantation to decipher the underlying mechanism of attenuated BRS in ESRD patients.
  
  
  METHODS
  We studied 23 ESRD patients (mean age; 36 years) prospectively before and at 3 and 6 months after RT. Baroreflex function was determined by spontaneous method (sequence and spectral indices). Short-term HRV and BPV were assessed using power spectrum analysis of RR intervals and systolic blood pressure by frequency domain analysis. Arterial stiffness indices were assessed by carotid-femoral pulse-wave velocity (PWV), augmentation index (AI) and central pulse pressure using Sphygmocor Vx device (AtCor Medical, Australia).
  
  
  RESULTS
  RT was associated with the normalization of BRS by 6 months. Arterial stiffness indices, such as AI and central pulse pressure, showed a significant reduction as early as 3 months after RT. PWV and frequency domain measures of HRV after RT did not show statistically significant changes except the LF/HF ratio which had a significant increase at 6 months when compared with baseline. Systolic BPV total power showed a significant reduction by 3 months after RT.
  
  
  CONCLUSIONS
  Our data suggest that RT normalizes BRS in ESRD patients by 6 months which follows the improvement in the AI and central pulse pressure.
authors.affiliation: Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Manpreet
authors.initials: M
authors.lastname: Kaur
authors.forename: Dinu
authors.initials: D
authors.lastname: Chandran
authors.forename: Charanjit
authors.initials: C
authors.lastname: Lal
authors.forename: Dipankar
authors.initials: D
authors.lastname: Bhowmik
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Jaryal
authors.forename: Kishore Kumar
authors.initials: KK
authors.lastname: Deepak
authors.forename: Sanjay Kumar
authors.initials: SK
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D017704:Baroreflex / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006339:Heart Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D059289:Vascular Stiffness / Q000502:physiology*
keywords: arterial stiffness; baroreflex sensitivity; blood pressure variability; end-stage renal disease; renal transplantation