ABSTRACT
Autonomic dysfunction is highly prevalent in patients with chronic kidney disease (CKD). Sympathetic overactivity is commonly described with direct microneurograph recordings of muscle sympathetic nerve activity indicating that it is substantially elevated and that this occurs early in the disease course. Heart rate variability (HRV) is widely measured in CKD patients as a means of examining autonomic regulation of the heart and is consistently reported as reduced, most notably in those receiving dialysis therapy. While it is largely appreciated that patients with CKD have reduced HRV, at what point within the development of CKD HRV begins to decline is as yet unknown. Anemia, a common feature of CKD patients, has a negative impact on autonomic function, leading to reduced parasympathetic function and a relative increase in sympathetic function. Within the general healthy population, HRV declines with age and as such, it is unsurprising that age is such a strong covariate.
