Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jan 6, 2016; 5(1): 53-65
Published online Jan 6, 2016. doi: 10.5527/wjn.v5.i1.53
Baroreflex dysfunction in chronic kidney disease
Manpreet Kaur, Dinu S Chandran, Ashok Kumar Jaryal, Dipankar Bhowmik, Sanjay Kumar Agarwal, Kishore Kumar Deepak
Manpreet Kaur, Dinu S Chandran, Ashok Kumar Jaryal, Kishore Kumar Deepak, Department of Physiology, All India Institute of Medical Sciences, New Delhi 110029, India
Dipankar Bhowmik, Sanjay Kumar Agarwal, Department of Nephrology, All India Institute of Medical Sciences, New Delhi 110029, India
Author contributions: Kaur M and Chandran DS performed the literature search and made the primary draft and draw the figures; Bhowmik D and Agarwal SK performed literature review and provided with clinical input about chronic kidney disease; Jaryal AK and Deepak KK suggested the theme to be reviewed and made the several critical corrections and revisions until the submitted version was achieved; Kaur M, Chandran DS, Jaryal AK and Deepak KK provided with the final draft of document.
Conflict-of-interest statement: The above-mentioned authors of this manuscript hereby declare that they do not have any conflict-of-interest (including but not limited to commercial, personal, political, intellectual, or religious interests) related to the work submitted herein.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ashok Kumar Jaryal, Professor of Physiology, Department of Physiology, All India Institute of Medical Sciences, Room No. 2009, Teaching block, Second floor, Ansari Nagar, New Delhi 110029, India. ashok.jaryal@gmail.com
Telephone: +91-90-13902960
Received: June 28, 2015
Peer-review started: July 13, 2015
First decision: September 17, 2015
Revised: November 5, 2015
Accepted: November 17, 2015
Article in press: November 25, 2015
Published online: January 6, 2016
Processing time: 192 Days and 0.6 Hours
Abstract

Chronic kidney disease (CKD) patients have high cardiovascular mortality and morbidity. The presence of traditional and CKD related risk factors results in exaggerated vascular calcification in these patients. Vascular calcification is associated with reduced large arterial compliance and thus impaired baroreflex sensitivity (BRS) resulting in augmented blood pressure (BP) variability and hampered BP regulation. Baroreflex plays a vital role in short term regulation of BP. This review discusses the normal baroreflex physiology, methods to assess baroreflex function, its determinants along with the prognostic significance of assessing BRS in CKD patients, available literature on BRS in CKD patients and the probable patho-physiology of baroreflex dysfunction in CKD.

Keywords: Large arterial compliance; Chronic kidney disease; Vascular calcification; Baroreflex sensitivity; Blood pressure variability

Core tip: Cardiovascular dysfunction is an important complication and risk factor of mortality and morbidity in chronic kidney disease (CKD). Baroreflex is a functional integrator of cardiovascular homeostasis. Derangement in baroreflex function is not only a manifestation of cardiovascular pathogenesis in general and in CKD but also contribute to ongoing etio-pathogenesis. The present review discusses the physiology and dysfunction in CKD in light of the available literature.