title: Potential role of endurance training in altering renal sympathetic nerve activity in CKD?
abstract: Chronic kidney disease (CKD), is characterized by a progressive loss of renal function and increase in cardiovascular risk. In this review paper, we discuss the pathophysiology of increased sympathetic nerve activity in CKD patients and raise the possibility of endurance exercise being an effective countermeasure to address this problem. We specifically focus on the potential role of endurance training in altering renal sympathetic nerve activity as increased renal sympathetic nerve activity negatively impacts kidney function as well indirectly effects multiple other systems and organs. Recent technological advances in device based therapy have highlighted the detrimental effect of elevated renal sympathetic nerve activity in CKD patients, with kidney function and blood pressure being improved post renal artery nerve denervation in selected patients. These developments provide optimism for the development of alternative and/or complementary strategies to lower renal sympathetic nerve activity. However, appropriately designed studies are required to confirm preliminary observations, as the widespread use of the renal denervation approach to lower sympathetic activity presently has limited feasibility. Endurance training may be one alternative strategy to reduce renal sympathetic nerve activity. Here we review the role of endurance training as a potential alternative or adjunctive to current therapy in CKD patients. We also provide recommendations for future research to assist in establishing an evidence base for the use of endurance training to lower renal sympathetic activity in CKD patients.
authors.affiliation: Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX 75231, United States; University of Texas Southwestern Medical Center, Dallas, TX 75231, United States; Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia. Electronic address: erin.howden@bakeridi.edu.au.
authors.forename: Erin J
authors.initials: EJ
authors.lastname: Howden
authors.affiliation: Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX 75231, United States; University of Texas Southwestern Medical Center, Dallas, TX 75231, United States.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Lawley
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia.
authors.forename: Murray
authors.initials: M
authors.lastname: Esler
authors.affiliation: Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX 75231, United States; University of Texas Southwestern Medical Center, Dallas, TX 75231, United States.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Levine
mesh_terms: D000818:Animals; D015444:Exercise / Q000502:physiology; D005081:Exercise Therapy; D006801:Humans; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology* / Q000628:therapy*; D013564:Sympathetic Nervous System / Q000503:physiopathology*
keywords: Autonomic function; Baroreflex; Blood pressure; End stage renal disease; Exercise; Kidney disease; Physical activity; Renal failure