Jeong Jinhee, Hu Yingtian, Zanuzzi Matias, DaCosta Dana, Sabino-Carvalho Jeann L, Li Sabrina, Park Jeanie
Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Veterans Affairs Health Care System, Decatur, Georgia, USA.
J Physiol. 2025 Jan;603(2):489-505. doi: 10.1113/JP287321. Epub 2024 Dec 18.
Chronic kidney disease (CKD) is characterized by overactivation of the sympathetic nervous system (SNS) that leads to increased risk of cardiovascular disease. This study was conducted to evaluate the effects of a Mindfulness-Based Stress Reduction (MBSR) programme on SNS activity in CKD patients. Participants with CKD stages III-IV were randomized to the 8 week MBSR programme or Health Enhancement Program (HEP; a structurally parallel, active control group). Intraneural measures of SNS activity directed to muscle [muscle sympathetic nerve activity (MSNA)] via microneurography was recorded at rest and during stress manoeuvres (mental arithmetic, handgrip exercise and cold pressor test). Data analyses were performed based on the intent-to-treat principle. In total, 29 participants (64 ± 9 years; 86% males) completed the intervention with 17 in the MBSR and 12 in the HEP groups. There was a significant Group (MBSR vs. HEP) by Time (baseline vs. post-intervention) interaction in MSNA reactivity to mental stress (P = 0.029), with a significant reduction in the mean ∆MSNA over 3 min of mental arithmetic at post-intervention (10.3 ± 4.2-5.9 ± 5.6 bursts/min, P < 0.001; Hedges' g = -0.858, 95% confidence interval [-1.578, -0.167]), while no change was observed within the HEP group (P = 0.818). Reduced ∆MSNA during handgrip exercise was also observed, while ∆MSNA during the cold pressor test and resting MSNA remained unchanged in both groups from baseline to post-intervention. In this randomized controlled trial, patients with CKD had a reduction of sympathetic reactivity during mental stress and static handgrip exercise following 8 weeks of MBSR but not after HEP. Our findings demonstrate that mindfulness training is feasible and may have clinically beneficial effects on autonomic function in CKD. KEY POINTS: Question: Does the Mindfulness-Based Stress Reduction (MBSR) programme reduce sympathetic activity in patients with chronic kidney disease (CKD)? Finding: In this randomized controlled trial including 29 patients with CKD, 8 weeks of MBSR decreased sympathetic reactivity to mental stress compared to the control Health Enhancement Program (HEP). Meaning: These finding suggest that mindfulness training may have clinically beneficial effects on autonomic function in CKD.
慢性肾脏病（CKD）的特征是交感神经系统（SNS）过度激活，这会导致心血管疾病风险增加。本研究旨在评估基于正念减压（MBSR）计划对CKD患者SNS活动的影响。将III-IV期CKD患者随机分为8周的MBSR计划组或健康促进计划（HEP；一个结构平行的积极对照组）。通过微神经ography记录静息和应激操作（心算、握力运动和冷加压试验）期间指向肌肉的SNS活动的神经内测量值[肌肉交感神经活动（MSNA）]。数据分析基于意向性分析原则进行。共有29名参与者（64±9岁；86%为男性）完成了干预，其中17名在MBSR组，12名在HEP组。在对精神应激的MSNA反应性方面，存在显著的组（MBSR与HEP）×时间（基线与干预后）交互作用（P = 0.029），干预后在心算3分钟期间平均∆MSNA显著降低（10.3±4.2-5.9±5.6次/分钟，P < 0.001；Hedges' g = -0.858，95%置信区间[-1.578，-0.167]），而HEP组未观察到变化（P = 0.818）。在握力运动期间也观察到∆MSNA降低，而在冷加压试验期间的∆MSNA和静息MSNA在两组从基线到干预后均保持不变。在这项随机对照试验中，CKD患者在接受8周的MBSR后，精神应激和静态握力运动期间的交感反应性降低，但接受HEP后未降低。我们的研究结果表明，正念训练是可行的，并且可能对CKD患者的自主神经功能产生临床有益影响。要点：问题：基于正念减压（MBSR）计划是否能降低慢性肾脏病（CKD）患者的交感神经活动？发现：在这项包括29名CKD患者的随机对照试验中，与对照健康促进计划（HEP）相比，8周的MBSR降低了对精神应激的交感反应性。意义：这些发现表明，正念训练可能对CKD患者的自主神经功能产生临床有益影响。
