Role of meditation in reducing sympathetic hyperactivity and improving quality of life in lupus nephritis patients with chronic kidney disease.
BACKGROUND
Lupus nephritis is an important leading cause of chronic kidney disease (CKD) among the young population in Thailand. Systemic lupus erythematosus (SLE) is often characterized by the presence of sympathetic hyperactivity, which results in a perishing outcome. Some physiological studies reveal that meditation may reduce this autonomic dysfunction. The authors hypothesized that meditation could be beneficial in alleviating the sympathetic hyperactivity and improving quality of life in lupus nephritis patients with CKD.


METHODS
The authors performed a prospective pilot study, which enrolled lupus nephritis patients and categorized enrollees into meditation group and control group. Method of meditation was instructed by an expert in Buddhist studies for a duration of 60 minutes every month. Participants in the intervention group were advised to meditate every day for 24 weeks. To evaluate change in sympathetic activity, normetanephrine level was measured at beginning and the end of study and compared between both groups. Quality of life was determined by SF-36. Heart rate variability was also assessed in meditation group.


RESULTS
Thirty eligible patients were recruited into the study. Fifteen patients were stratified in the meditation group and 15 patients in the control group. After meditation for 6 months, serum normetanephrine level decreased, but without statistical significance (0.105 vs. 0.059, p = 0.28). The reduction in normetanephrine level was also observed in the control group (p = 0.11). In the aspect of quality of life, scores of physical and mental components improved significantly. In meditation group, physical component score increased from 21.4 (5.0-50.2) to 62.2 (51.8-88.4) points (p < 0.01) and mental score increased from 16.9 (4.4-46.0) to 72.4 (45.1-81.6) points (p < 0.01). Quality of life score in the meditation group significantly increased more than in control group (p < 0.01). The parameter of heart rate variability in time and frequency domain also improved in the meditation group.


CONCLUSIONS
In lupus nephritis patients with CKD, meditation shows a trend of benefits in reducing sympathetic overactivity and improving quality of life. Our results support the important role of meditation as a valuable adjunctive treatment of lupus nephritis with CKD.
Sirawit
S
Bantornwan
Wattana B
WB
Watanapa
Poungpetch
P
Hussarin
Somruedee
S
Chatsiricharoenkul
Nuttasith
N
Larpparisuth
Tanyarat
T
Teerapornlertratt
Jutamas
J
Vareesangthip
Kriengsak
K
Vareesangthip
D000328:Adult; D000368:Aged; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008181:Lupus Nephritis / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D019122:Meditation; D008875:Middle Aged; D009647:Normetanephrine / Q000097:blood; D011446:Prospective Studies; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000209:etiology; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D055815:Young Adult
D009647:Normetanephrine