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The present review focuses on recent findings on the sympathetic nervous system activity in these patients. Sympathetic overactivity has been demonstrated directly by muscle sympathetic nerve activity recordings (<jats:styled-content style=\"fixed-case\">MSNA<\/jats:styled-content>) in chronic renal disease, but only rarely in HD patients. In the latter, sympathetic activity has mostly been assessed using indirect methodology. Decreased heart rate variability, increased blood pressure variability (BPV), and suppressed baroreflex function are believed to represent chronic sympathetic overactivity in HD patients. The HD procedure and ultrafiltration are associated with enhanced sympathetic activity and baroreflex activation. During most episodes of intradialytic hypotension, the baroreflex is adequately activated; sympathetic withdrawal with bradycardia, however, has been reported during excessive hypovolemia. Sympathetic overactivity is also believed to be a mechanism associated with intradialytic hypertensive episodes and refractory hypertension. While successful renal transplantation is associated with improvement of heart rate variability (HRV), improvement and restoration of baroreflex function, persistent sympathetic overactivity has been documented in transplanted patients using <jats:styled-content style=\"fixed-case\">MSNA<\/jats:styled-content> recordings. Decreased HRV and baroreflex function have been reported to be associated with increased mortality and morbidity in HD patients. The predictive value of sympathetic outflow assessed by <jats:styled-content style=\"fixed-case\">MSNA<\/jats:styled-content> has yet to be determined. Optimization of HD treatment, pharmacological interventions, and renal sympathetic denervation are several approaches targeting sympathetic overactivity to improve cardiovascular morbidity and mortality.<\/jats:p>","DOI":"10.1111\/sdi.12093","type":"journal-article","created":{"date-parts":[[2013,4,30]],"date-time":"2013-04-30T04:11:38Z","timestamp":1367295098000},"page":"333-343","source":"Crossref","is-referenced-by-count":81,"title":["Sympathetic Nervous System Function and Dysfunction in Chronic Hemodialysis Patients"],"prefix":"10.1111","volume":"26","author":[{"given":"Dvora","family":"Rubinger","sequence":"first","affiliation":[{"name":"Nephrology and Hypertension Services Hadassah University Medical Center Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Backenroth","sequence":"additional","affiliation":[{"name":"Nephrology and Hypertension Services Hadassah University Medical Center Jerusalem 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