{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T06:01:41Z","timestamp":1785477701380,"version":"3.56.0"},"reference-count":117,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:p>Chronic kidney disease (CKD) confers disproportionate high risk for cardiovascular morbidity and mortality. Hypertension remains both a driver and consequence of progressive renal dysfunction. Beyond sodium retention, volume expansion, and renin\u2013angiotensin\u2013aldosterone system activation, increasing evidence supports a CKD phenotype of sustained sympathetic activation coupled with impaired autonomic buffering and altered vascular responsiveness. Baroreflex sensitivity is reduced across pre-dialysis and dialysis cohorts and is linked to arterial stiffening and vascular calcification, changes that amplify blood pressure variability and central hemodynamic load. In parallel, CKD has been associated with enhanced \u03b11-adrenergic responsiveness, suggesting that sympathetic neurovascular transduction may be altered and thereby contribute to elevated total peripheral resistance and blood pressure lability. Renal denervation (RDN) disrupts renal sympathetic nerve traffic and has re-emerged as an adjunctive therapy for selected patients with uncontrolled or resistant hypertension in contemporary international guidelines. By attenuating renal efferent signaling and interrupting afferent kidney\u2013brain reflex pathways, RDN provides both a therapeutic option and a translational probe into the kidney\u2019s contribution to global sympathetic drive. In end-stage kidney disease, early proof-of-concept studies demonstrate feasibility and report reductions in sympathetic indices in subsets undergoing repeat physiological assessment. This review summarizes current evidence on vascular function and autonomic control of the vasculature in CKD, emphasizing kidney\u2013brain signaling, baroreflex impairment, endothelial dysfunction, arterial stiffening, and neurovascular transduction, and examines available evidence for RDN in patients with diminished renal function. We highlight mechanistic gaps, responder phenotypes, and priorities for future research aimed at targeted neuromodulation strategies in CKD.<\/jats:p>","DOI":"10.3389\/fnins.2026.1863953","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T05:38:29Z","timestamp":1785476309000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Autonomic control of the vasculature in CKD: leveraging renal denervation"],"prefix":"10.3389","volume":"20","author":[{"given":"Gianni","family":"Sesa-Ashton","sequence":"first","affiliation":[{"name":"Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute","place":["Melbourne, VIC, Australia"]},{"name":"Dobney Hypertension Centre, Royal Perth Hospital, University of Western Australia","place":["Perth, WA, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Revathy","family":"Carnagarin","sequence":"additional","affiliation":[{"name":"Dobney Hypertension Centre, Royal Perth Hospital, University of Western Australia","place":["Perth, WA, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Woodhams","sequence":"additional","affiliation":[{"name":"Dobney Hypertension Centre, Royal Perth Hospital, University of Western Australia","place":["Perth, WA, Australia"]},{"name":"Royal Perth Hospital Research Foundation","place":["Perth, WA, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lakshini","family":"Herat","sequence":"additional","affiliation":[{"name":"Dobney Hypertension Centre, Royal Perth Hospital, University of Western Australia","place":["Perth, WA, Australia"]},{"name":"Royal Perth Hospital Research Foundation","place":["Perth, WA, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus P.","family":"Schlaich","sequence":"additional","affiliation":[{"name":"Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute","place":["Melbourne, VIC, Australia"]},{"name":"Dobney Hypertension Centre, Royal Perth Hospital, University of Western Australia","place":["Perth, WA, Australia"]},{"name":"Royal Perth Hospital Research Foundation","place":["Perth, WA, Australia"]},{"name":"Departments of Cardiology and Nephrology, Royal Perth Hospital","place":["Perth, WA, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e034568","DOI":"10.1161\/jaha.124.034568","article-title":"Trends of blood pressure control in chronic kidney disease among US adults: findings from NHANES 2011 to 2020.","volume":"13","author":"Akbari","year":"2024","journal-title":"J. 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