Marie Hilderman1 and Annette Bruchfeld1,2
ABSTRAC: TInflammation and autonomic dysfunction are common find-ings in chronic and end-stage kidney disease and contribute to amarkedly increased risk of mortality in this patient population.The cholinergic anti-inflammatory pathway (CAP) is a vagalneuro-immune circuit that upholds the homoeostatic balanceof inflammatory activity in response to cell injury and patho-gens. CAP models have been examined in preclinical studies toinvestigate its significance in a range of clinical inflammatoryconditions and diseases. More recently, cervical vagus nervestimulation (VNS) implants have been shown to be of potentialbenefit for patients with chronic autoimmune diseases such asrheumatoid arthritis and inflammatory bowel disease. We havepreviously shown that dialysis patients have a functional CAPex vivo. Here we review the field and the potential role of theCAP in acute kidney injury and chronic kidney disease (CKD)as well as in hypertension. We also present a VNS pilot study inhaemodialysis patients. Controlling inflammation by neuroim-mune modulation may lead to new therapeutic modalities forimproved treatment, outcome, prognosis and quality of life forpatients with CKD.
