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Differential distribution of muscle and skin sympathetic nerve activity in patients with end-stage renal disease

¹Division of Nephrology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; ²Division of Nephrology, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California; and ³Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California

Submitted 1 July 2008 ; accepted in final form 2 October 2008

End-stage renal disease (ESRD) is characterized by resting sympathetic overactivity. Baseline muscle sympathetic nerve activity (MSNA), which is governed by baroreflexes and chemoreflexes, is elevated in ESRD. Whether resting skin sympathetic nerve activity (SSNA), which is independent from baroreflex and chemoreflex control, is also elevated has never been reported in renal failure. The purpose of this study was to determine whether sympathetic overactivity of ESRD is generalized to include the skin distribution. We measured sympathetic nerve activity to both muscle and skin using microneurography in eight ESRD patients and eight controls. MSNA was significantly (P = 0.025) greater in ESRD (37.3 ± 3.6 bursts/min) when compared with controls (23.1 ± 4.4 bursts/min). However, SSNA was not elevated in ESRD (ESRD vs. controls, 17.6 ± 2.2 vs. 16.1 ± 1.7 bustst/min, P = 0.61). Similar results were obtained when MSNA was quantified as bursts per 100 heartbeats. We report the novel finding that although sympathetic activity directed to muscle is significantly elevated, activity directed to skin is not elevated in ESRD. The differential distribution of sympathetic outflow to the muscle vs. skin in ESRD is similar to the pattern seen in other disease states characterized by sympathetic overactivity such as heart failure and obesity.

dialysis

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				C. N. Young, D. M. Keller, C. G. Crandall, and P. J. Fadel Comparing resting skin sympathetic nerve activity between groups: caution needed J Appl Physiol, May 1, 2009; 106(5): 1751 - 1752. [Full Text] [PDF]

				H. R. Middlekauff and J. Park Reply to Young et al. J Appl Physiol, May 1, 2009; 106(5): 1753 - 1753. [Full Text] [PDF]