Baroreceptor Sensitivity in Individuals with Chronic Kidney Disease and Heart Failure

Background: Heart failure is the most common cardiovascular complication of chronic kidney disease and foreshadows high morbidity and mortality. Baroreflex impairment likely contributes to the cardiovascular mortality. We aimed to study the associations between chronic kidney disease, heart failure and baroreflex sensitivity (BRS) as well as their association with cardiovascular outcomes Methods: We analyzed data from a previously recruited cohort study which included 247 individuals with moderate-to-severe HF. All subjects underwent BRS measurements after intravenous phenylephrine along with electrocardiography, echocardiography and laboratory measurements. We used logistic regression models to assess the association of CKD with BRS using iterative models. Cox proportional hazards models were used to assess associations of binary BRS and subgroups according to categorizations of CKD and BRS with cardiovascular mortality Results: Median eGFR among individuals with CKD was 52 (IQR 44-56) mL/min/1.73m2 eGFR was lower in those with depressed BRS (65 IQR 54-76 mL/min/1.73m2) compared to those with preserved BRS (73 IQR 64-87 mL/min/1.73m2, P=<0.001). The majority of individuals with CKD had depressed BRS compared to those without CKD (60.3% vs. 29.1%, P=0.05). In regression models, CKD and BRS were independently associated. Cardiovascular mortality was significantly increased in individuals with or without CKD and depressed BRS compared to those with preserved BRS and CKD. Conclusions: Cardiac BRS is depressed in patients with CKD and HF and may be an important contributor to cardiovascular mortality.