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Chronic Kidney Disease As a Potential Indication for Renal Denervation
Margreet F Sanders1, Peter J Blankestijn1
1Department of Nephrology and Hypertension, University Medical Centre Utrecht Utrecht, Netherlands.
Frontiers in Physiology
|July 5, 2016
Summary
Renal denervation shows variable effectiveness for resistant hypertension. This review suggests patients with chronic kidney disease may particularly benefit from this blood pressure lowering therapy due to heightened renal sympathetic nerve activity.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Management
Background:
- Treatment-resistant hypertension (TRH) management remains challenging.
- Renal denervation (RD) is an emerging therapy for TRH, but its effectiveness varies widely.
- The heterogeneity in RD outcomes may stem from diverse underlying causes of hypertension.
Purpose of the Study:
- To explore the pathophysiological rationale for using renal denervation in specific patient groups.
- To identify patient populations most likely to benefit from renal denervation.
- To argue that chronic kidney disease (CKD) patients are particularly suited for renal denervation.
Main Methods:
- Review of existing pathophysiological and clinical data on renal sympathetic nerve activity in hypertension.
- Analysis of the mechanism of action for renal denervation.
- Correlation of renal sympathetic nerve activity with hypertension pathogenesis and CKD.
Main Results:
- Renal sympathetic nerve activity (afferent and efferent) plays a significant role in hypertension.
- RD targets the disruption of these nerves around the renal arteries.
- CKD is characterized by increased renal sympathetic nerve activity, suggesting RD suitability.
Conclusions:
- The heterogeneous response to RD in TRH highlights the need for patient selection.
- Increased renal sympathetic nerve activity is a key factor in hypertension, particularly in CKD.
- RD presents a promising therapeutic option for hypertensive patients with chronic kidney disease.
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