Impaired baroreflex sensitivity predicts mortality in chronic kidney disease

Autonomic nervous system dysfunction is common in patients with chronic kidney disease (CKD) and is associated with adverse cardiovascular (CV) outcomes and mortality in non-CKD populations, but has not previously been shown to predict all cause mortality in CKD. 134 patients were recruited to an observational study. CV structure, function and inflammatory status were quantified. Survival was assessed at 4 years. There were 38 fatalities. Unadjusted Cox-regression analysis demonstrated lowest fertile baroreflex sensitivity (BRS) increased mortality risk by 2.43x. Stepwise multivariate analysis showed that this effect was independent of age, inflammation and vascular calcification. Reduced BRS is common in CKD, however even within such a population lowest values were still independently associated with additional mortality.