Future perspective on chronic kidney disease management

Over-activation of the sympathetic nervous system is one of the major characteristics in chronic kidney disease (CKD), with renal ischemia playing a pivotal role in its development. While various pharmacologic strategies have been introduced to suppress sympathetic activity and slow the CKD progression, these approaches are often hindered by challenges such as limited effectiveness, drug resistance, adverse effects, and poor patient adherence. Renal denervation has emerged as a potential alternative that directly targets sympathetic nerve activity, and numerous studies have highlighted its promise. However, the outcomes of renal denervation remain variable, and the procedure carries the risk of disrupting the regulatory functions of the renal nervous system. Thoracic epidural blockade presents a novel therapeutic option for CKD management by modulating sympathetic nervous system activity. This review attempts to explore the pathophysiology of CKD, the involvement of the sympathetic nervous system in disease progression, the limitations of current pharmacologic treatments and renal denervation, and the potential benefits of thoracic epidural blockade in managing CKD.