Review Potential role of endurance training in altering renal sympathetic nerve activity in CKD? Erin J Howden a,b,c, ⁎, Justin S Lawley a,b , Murray Esler c , Benjamin D. Levine a,b a Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX 75231, United States b University of Texas Southwestern Medical Center, Dallas, TX 75231, United States c Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia abstract article info Article history: Received 1 July 2016 Received in revised form 16 November 2016 Accepted 23 November 2016 Available online xxxx Chronic kidney disease (CKD), is characterized by a progressive loss of renal function and increase in cardiovas- cular risk. In this review paper, we discuss the pathophysiology of increased sympathetic nerve activity in CKD patients and raise the possibility of endurance exercise being an effective countermeasure to address this prob- lem. We specifically focus on the potential role of endurance training in altering renal sympathetic nerve activity as increased renal sympathetic nerve activity negatively impacts kidney function as well indirectly effects multi- ple other systems and organs. Recent technological advances in device based therapy have highlighted the det- rimental effect of elevated renal sympathetic nerve activity in CKD patients, with kidney function and blood pressure being improved post renal artery nerve denervation in selected patients. These developments provide optimism for the development of alternative and/or complementary strategies to lower renal sympathetic nerve activity. However, appropriately designed studies are required to confirm preliminary observations, as the widespread use of the renal denervation approach to lower sympathetic activity presently has limited feasi- bility. Endurance training may be one alternative strategy to reduce renal sympathetic nerve activity. Here we re- view the role of endurance training as a potential alternative or adjunctive to current therapy in CKD patients. We also provide recommendations for future research to assist in establishing an evidence base for the use of endur- ance training to lower renal sympathetic activity in CKD patients. © 2016 Elsevier B.V. All rights reserved. Keywords: Exercise Physical activity Baroreflex Autonomic function Blood pressure Kidney disease Renal failure End stage renal disease Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2. Sympatho-excitation in CKD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3. Assessing renal sympathetic activity in humans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 4. Effect of endurance exercise training on sympathetic activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 5. Proposed mechanisms for role of exercise training in lowering renal sympathetic activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 5.1. Central inhibition of sympathetic activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 5.2. Baroreflex mediated suppression of sympathetic activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 6. Future directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 7. Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1. Introduction The aging population, combined with the growing burden of type 2 diabetes and hypertension contribute significantly to the increasing number of patients living with chronic kidney disease (CKD). Patients with CKD have a markedly elevated cardiovascular mortality (Go et al., 2004). A potential silent contributor to the high cardiovascular risk Autonomic Neuroscience: Basic and Clinical xxx (2016) xxx–xxx ⁎ Corresponding author at: Baker IDI Diabetes and Heart Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia. E-mail address: erin.howden@bakeridi.edu.au (E.J. Howden). AUTNEU-01897; No of Pages 7 http://dx.doi.org/10.1016/j.autneu.2016.11.002 1566-0702/© 2016 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect Autonomic Neuroscience: Basic and Clinical journal homepage: www.elsevier.com/locate/autneu Please cite this article as: Howden, E.J., et al., Potential role of endurance training in altering renal sympathetic nerve activity in CKD?, Auton. Neurosci. (2016), http://dx.doi.org/10.1016/j.autneu.2016.11.002