# Sympatho-inhibition with Mindfulness in Chronic Kidney Disease

> **NIH NIH R61** · EMORY UNIVERSITY · 2020 · $461,157

## Abstract

~30 million people in the US have chronic kidney disease (CKD) and are at significantly increased risk of
cardiovascular (CV) disease and mortality. One major mechanism contributing to increased CV risk in this
patient population is chronic over-activation of the sympathetic nervous system (SNS). SNS overactivity in
CKD leads to difficult-to-control blood pressure (BP), and an abnormal circadian rhythm of BP characterized by
failure to decrease BP at night (i.e. nondipping), that is independently associated with increased CV risk.
Current strategies to combat SNS overactivation, however, are limited to sympatholytic medications that are
often poorly tolerated with adverse side effects. Therefore, there is a critical need to develop novel, safe, and
well-tolerated strategies for reducing SNS activity to improve clinical CV outcomes in this highly prevalent and
growing population of CKD patients. One such novel approach at improving hemodynamics and autonomic
function in CKD is mindfulness meditation (MM). Multiple prior studies have shown that MM, and specifically
mindfulness-based stress reduction (MBSR), significantly reduces BP in a variety of patient populations.
However, the mechanisms underlying the BP-lowering effect of MM are unclear. Small studies using indirect
measures have suggested that MM may modulate the autonomic nervous system; however, no prior studies
have used direct, gold-standard methods to interrogate the sustained effects of MM-based interventions on
SNS. We performed the first studies using direct, intraneural measurements of muscle sympathetic nerve
activity (MSNA) that demonstrate that MM acutely reduces BP and MSNA in CKD. In Aim1 (R61), we will test
the hypothesis that 8 weeks of MBSR leads to sustained reductions in MSNA that are linked to improvements
in daytime BP, and improved nocturnal dipping of BP in CKD. Following these studies, we will determine if
transcutaneous vagus nerve stimulation (tVNS), a simple, noninvasive, self-administered adjunctive therapy,
enhances the sympatho-inhibitory effects of MM in CKD. The vagus nerve, the major effector of the
parasympathetic nervous system (PNS), is comprised of afferent nerve fibers that connect to the nucleus
tractus solitarii (NTS) and other brainstem regions that influence central SNS output and baroreflexes, and
efferent nerve fibers that activate the cholinergic anti-inflammatory pathway. Both experimental and human
studies have demonstrated that tVNS reduces SNS activity, improves baroreflex sensitivity (BRS), and lowers
inflammation, and our preliminary data demonstrate that tVNS reduces MSNA and improves BRS in CKD. In
Aim 2 (R33), we will test the hypothesis that tVNS augments the beneficial effects of MBSR on MSNA and
ambulatory BP profiles, and ameliorates SNS overactivation by improving arterial BRS and reducing
inflammation in CKD. These studies will elucidate autonomic mechanisms underlying the beneficial effects of
MM in CKD, while addressing a critical...

## Key facts

- **NIH application ID:** 9995421
- **Project number:** 5R61AT010457-02
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Jeanie Park
- **Activity code:** R61 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $461,157
- **Award type:** 5
- **Project period:** 2019-09-01 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9995421

## Citation

> US National Institutes of Health, RePORTER application 9995421, Sympatho-inhibition with Mindfulness in Chronic Kidney Disease (5R61AT010457-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9995421. Licensed CC0.

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