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Scalise F, Quarti-Trevano F, Toscano E, Sorropago A, Vanoli J, Grassi G. Renal Denervation in End-Stage Renal Disease: Current Evidence and Perspectives. High Blood Press Cardiovasc Prev 2024; 31:7-13. [PMID: 38267652 PMCID: PMC10925565 DOI: 10.1007/s40292-023-00621-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024] Open
Abstract
In patients with end-stage renal disease (ESRD) undergoing haemodialysis, hypertension is of common detection and frequently inadequately controlled. Multiple pathophysiological mechanisms are involved in the development and progression of the ESRD-related high blood pressure state, which has been implicated in the increased cardiovascular risk reported in this hypertensive clinical phenotype. Renal sympathetic efferent and afferent nerves play a relevant role in the development and progression of elevated blood pressure values in patients with ESRD, often leading to resistant hypertension. Catheter-based bilateral renal nerves ablation has been shown to exert blood pressure lowering effects in resistant hypertensive patients with normal kidney function. Promising data on the procedure in ESRD patients with resistant hypertension have been reported in small scale pilot studies. Denervation of the native non-functioning kidney's neural excitatory influences on central sympathetic drive could reduce the elevated cardiovascular morbidity and mortality seen in ESRD patients. The present review article will focus on the promising results obtained with renal denervation in patients with ESRD, its mechanisms of action and future perspectives in these high risk patients.
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Affiliation(s)
- Filippo Scalise
- Department of Interventional Cardiology, Policlinico di Monza, Monza, Italy
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20052, Monza, Milan, Italy
| | - Evelina Toscano
- Department of Interventional Cardiology, Policlinico di Monza, Monza, Italy
| | - Antonio Sorropago
- Department of Interventional Cardiology, Policlinico di Monza, Monza, Italy
| | - Jennifer Vanoli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20052, Monza, Milan, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20052, Monza, Milan, Italy.
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Mazza A, Dell'Avvocata F, Torin G, Bulighin F, Battaglia Y, Fiorini F. Does Renal Denervation a Reasonable Treatment Option in Hemodialysis-Dependent Patient with Resistant Hypertension? A Narrative Review. Curr Hypertens Rep 2023; 25:353-363. [PMID: 37672130 PMCID: PMC10598141 DOI: 10.1007/s11906-023-01264-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE OF REVIEW This narrative review aims to assess the pathophysiology, diagnosis, and treatment of resistant hypertension (RH) in end-stage kidney disease (ESKD) patients on dialysis, with a specific focus on the effect of renal denervation (RDN) on short-term and long-term blood pressure (BP) control. Additionally, we share our experience with the use of RDN in an amyloidotic patient undergoing hemodialysis with RH. RECENT FINDINGS High BP, an important modifiable cardiovascular risk factor, is often observed in patients in ESKD, despite the administration of multiple antihypertensive medications. However, in clinical practice, it remains challenging to identify RH patients on dialysis treatment because of the absence of specific definition for RH in this context. Moreover, the use of invasive approaches, such as RDN, to treat RH is limited by the exclusion of patients with reduced renal function (eGFR < 45 mL/min/1.73 m3) in the clinical trials. Nevertheless, recent studies have reported encouraging results regarding the effectiveness of RDN in stage 3 and 4 chronic kidney disease (CKD) and ESKD patients on dialysis, with reductions in BP of nearly up to 10 mmhg. Although multiple underlying pathophysiological mechanisms contribute to RH, the overactivation of the sympathetic nervous system in ESKD patients on dialysis plays a crucial role. The diagnosis of RH requires both confirmation of adherence to antihypertensive therapy and the presence of uncontrolled BP values by ambulatory BP monitoring or home BP monitoring. Treatment involves a combination of nonpharmacological approaches (such as dry weight reduction, sodium restriction, dialysate sodium concentration reduction, and exercise) and pharmacological treatments. A promising approach for managing of RH is based on catheter-based RDN, through radiofrequency, ultrasound, or alcohol infusion, directly targeting on sympathetic overactivity.
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Affiliation(s)
- Alberto Mazza
- ESH Excellence Hpertension Centre and Dept. of Internal Medicine, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - Fabio Dell'Avvocata
- Cardiovascular Diagnosis and Endoluminal Interventions Unit, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - Gioia Torin
- ESH Excellence Hpertension Centre and Dept. of Internal Medicine, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - Francesca Bulighin
- Department of Medicine, University of Verona, 37129, Verona, Italy
- Nephrology and Dialysis Unit, Pederzoli Hospital, Via Monte Baldo, 24, 37019, Peschiera del Garda, Italy
| | - Yuri Battaglia
- Department of Medicine, University of Verona, 37129, Verona, Italy.
- Nephrology and Dialysis Unit, Pederzoli Hospital, Via Monte Baldo, 24, 37019, Peschiera del Garda, Italy.
| | - Fulvio Fiorini
- Nephrology, Dialysis and Dietology Unit, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy
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Li S, Phillips JK. Patient Selection for Renal Denervation in Hypertensive Patients: What Makes a Good Candidate? Vasc Health Risk Manag 2022; 18:375-386. [PMID: 35592729 PMCID: PMC9113553 DOI: 10.2147/vhrm.s270182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/22/2022] [Indexed: 01/03/2023] Open
Affiliation(s)
- Sheran Li
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Emergency Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
- Correspondence: Sheran Li, Department of Emergency Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 West Yanjiang Road, Yuexiu District, Guangzhou, Guangdong Province, 510120, People’s Republic of China, Tel +86 20 81332723, Fax +86 20 8133 2650, Email
| | - Jacqueline K Phillips
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Effects of renal denervation on blood pressure in hypertensive patients with end-stage renal disease: a single centre experience. Clin Exp Nephrol 2019; 23:749-755. [DOI: 10.1007/s10157-019-01697-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/17/2019] [Indexed: 11/27/2022]
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Pietilä-Effati PM, Salmela AK, Koistinen MJ. Intravascular Renal Denervation in Renal Dialysis Patients with Uncontrolled Hypertension: A Case Series of Four Patients. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:985-991. [PMID: 30127334 PMCID: PMC6111771 DOI: 10.12659/ajcr.909820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Case series Patient: Male, 24 • Female, 55 • Female, 56 • Male, 72 Final Diagnosis: Hypertension Symptoms: Dyspnea Medication: — Clinical Procedure: Intravascular renal denervation Specialty: Cardiology
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Affiliation(s)
| | - Anna K Salmela
- Department of Nephrology, Vaasa Central Hospital, Vaasa, Finland
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Okamura K, Shirai K, Okuda T, Urata H. The Prevalence of Japanese Outpatients with Hypertension Who Meet the Definition of Treatment Resistant Hypertension and Are Eligible for Enrolment in Clinical Trials of Endovascular Ultrasound Renal Denervation. Intern Med 2018; 57:1-12. [PMID: 29033430 PMCID: PMC5799049 DOI: 10.2169/internalmedicine.9059-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective A clinical trial (REQUIRE) was started to investigate the use of an ultrasound renal denervation system in the treatment of resistant hypertension (RHT). We analyzed the prevalence of patients who were eligible for inclusion in this cross-sectional study at the time of screening. Methods Nine-hundred ninety-nine consecutive hypertension (HT) patients who were treated in our hospital as outpatients were classified into the following categories: patients treated with at least 3 types of antihypertensive drugs including diuretic agents who were eligible for enrolment in SYMPLICITY HTN-Japan (SH-J) with an office systolic blood pressure (SBP) of ≥160 mmHg, who were ≤80 years of age, and an estimated glomerular filtration rate (eGFR) of ≥45 mL/min/1.73 m2 (RHT-S); and patients who were treated similar medications and who were eligible for enrolment in REQUIRE, with an SBP of ≥150 mmHg, ≤75 years of age, and an eGFR of ≥40 mL/min/1.73 m2 (RHT-R). We investigated the proportion of patients in each category. We also investigated HT patients (1,423 cases) who were enrolled in the Chikushi Anti-Hypertension Trial (CHAT), a research network that includes general practitioners. Results Eleven patients (1.1%) with RHT-S and 18 patients (1.8%) with RHT-R were identified. After the exclusion of patients with secondary HT and a diastolic blood pressure (DBP) of <90 mmHg (applied in REQUIRE), 5 patients (0.5%) with RHT-S and 4 patients (0.4%) with RHT-R remained. In the analysis of the CHAT study, only 2 (0.1%) patients with RHT-R remained. Conclusion The number of eligible patients in the REQUIRE trial was decreased, largely due to the strict age restriction and the new DBP limitation. The prevalence of eligible patients in REQUIRE was estimated to be approximately 0.5 to 0.8 times that in SH-J. Since patient enrollment will be difficult, drastic measures may be required to recruit eligible patients.
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Affiliation(s)
- Keisuke Okamura
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Japan
| | - Kazuyuki Shirai
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Japan
| | - Tetsu Okuda
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Japan
| | - Hidenori Urata
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Japan
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Hoye NA, Wilson LC, Wilkins GT, Jardine DL, Putt TL, Samaranayaka A, Schollum JBW, Walker RJ. Endovascular Renal Denervation in End-Stage Kidney Disease Patients: Cardiovascular Protection-A Proof-of-Concept Study. Kidney Int Rep 2017; 2:856-865. [PMID: 29270493 PMCID: PMC5733679 DOI: 10.1016/j.ekir.2017.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/17/2017] [Accepted: 04/26/2017] [Indexed: 01/28/2023] Open
Abstract
Introduction Sympathetic neural activation is markedly increased in end-stage kidney disease (ESKD). Catheter-based renal denervation (RDN) reduces sympathetic overactivity and blood pressure in resistant hypertension. We investigated the effect of RDN on sympathetic neural activation and left ventricular mass in patients with ESKD. Methods Nine ESKD (6 hemodialysis and 3 peritoneal dialysis) patients with dialysis vintage of ≥11 months were treated with RDN (EnligHTN system). Data were obtained on a nondialysis day; at baseline, 1, 3, and 12 months post-RDN. Results At baseline sympathetic neural activation measured by muscle sympathetic nervous activity (MSNA) and plasma norepinephrine concentrations were markedly elevated. Left ventricular hypertrophy (LVH) was evident in 8 of the 9 patients. At 12 months post-RDN, blind analysis revealed that MSNAfrequency (–12.2 bursts/min1, 95% CI [–13.6, –10.7]) and LV mass (–27 g/m2, 95% CI [–47, –8]) were reduced. Mean ambulatory BP (systolic: –24 mm Hg, 95% CI [–42, –5] and diastolic: –13 mm Hg, 95% CI [–22, –4]) was also reduced at 12 months. Office BP was reduced as early as 1 month (systolic: –25 mm Hg, 95% CI [–45, –5] and diastolic: –13 mm Hg, 95% CI [–24, –1]). Both ambulatory and office BP had clinically significant reductions in at least 50% of patients out to 12 months. Discussion Catheter-based RDN significantly reduced MSNA and LV mass as well as systemic BP in this group of patients with ESKD.
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Affiliation(s)
- Neil A Hoye
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, Otago, New Zealand.,Department of Renal Medicine, St. James's University Hospital, Leeds, UK
| | - Luke C Wilson
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Gerard T Wilkins
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - David L Jardine
- Department of Medicine, University of Otago, Christchurch, Otago, New Zealand
| | - Tracey L Putt
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Ari Samaranayaka
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - John B W Schollum
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Robert J Walker
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, Otago, New Zealand
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Effect of renal denervation on kidney function in patients with chronic kidney disease. Int J Cardiol 2017; 232:93-97. [PMID: 28089459 DOI: 10.1016/j.ijcard.2017.01.047] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/19/2016] [Accepted: 01/04/2017] [Indexed: 11/20/2022]
Abstract
AIMS Renal denervation (RDN) can reduce blood pressure (BP) and slow the decline of renal function in chronic kidney disease (CKD) up to one year. Whether this effect is maintained beyond 12months and whether the magnitude of BP reduction affects estimated glomerular filtration rate (eGFR) is unknown. METHODS AND RESULTS We examined eGFR in 46 CKD patients (baseline eGFR ≤60mL/min/1.73m2) on a yearly basis from 60months before to 3, 6, 12 and 24months after RDN. Ambulatory BP was measured before and after RDN. Linear mixed models analysis demonstrated a significant progressive decline in eGFR from months 60 to 12months (-15.47±1.98mL/min/1.73m2, P<0.0001) and from 12months to baseline prior to RDN (-3.41±1.64mL/min/1.73m2, P=0.038). Compared to baseline, RDN was associated with improved eGFR at 3months (+3.73±1.64mL/min/1.73m2, P=0.02) and no significant changes at 6 (+2.54±1.66mL/min/1.73m2, P=0.13), 12 (+1.78±1.64mL/min/1.73m2, P=0.28), and 24 (-0.24±2.24mL/min/1.73m2, P=0.91) months post procedure were observed. RDN significantly reduced daytime SBP from baseline to 24months post procedure (148±19 vs 136±17mmHg, P=0.03) for the entire cohort. Changes in SBP were unrelated to the eGFR changes at 6 (r=0.033, P=0.84), 12 (r=0.01, P=0.93) and 24months (r=-0.42, P=0.17) follow-up. CONCLUSION RDN can slow further deterioration of renal function irrespective of BP lowering effects in CKD. RDN-induced inhibition of sympathetic outflow to the renal vascular bed may account for improved eGFR via alterations of intrarenal and glomerular hemodynamics.
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Raju N, Lloyd V, Yalagudri S, Das B, Ravikishore AG. Renal denervation in a patient with Alport syndrome and rejected renal allograft. Indian Heart J 2016; 67 Suppl 3:S71-3. [PMID: 26995439 PMCID: PMC4799009 DOI: 10.1016/j.ihj.2015.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 11/29/2015] [Accepted: 12/02/2015] [Indexed: 12/27/2022] Open
Abstract
Renal denervation is a new intervention to treat resistant hypertension. By applying radiofrequency (RF) to renal arteries, sympathetic nerves in adventitia layer of vascular wall can be denervated. Sympathetic hyperactivity is an important contributory factor in hypertension of hemodialysis patients. Hyperactive sympathetic nervous system aggravates hypertension and it can cause complications like left ventricular hypertrophy, heart failure, arrhythmias and atherogenesis. Our report illustrates the use of renal denervation using conventional RF catheter for uncontrolled hypertension in a patient with Alport syndrome and rejected renal allograft. Progressive and sustained reduction of blood pressure was obtained post-procedure and at 24 months follow-up with antihypertensives decreased from 6 to 2 per day, thereby demonstrating the safety, feasibility, and efficacy of the procedure. There are some reports available on the usefulness of this technique in hemodialysis patients; however, there are no studies of renal denervation in patients with Alport syndrome and failed allograft situation.
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Affiliation(s)
- Narayana Raju
- Senior Resident, Department of Cardiology, Narayana Hrudayalaya, Bangalore, India.
| | - Vincent Lloyd
- Senior Consultant Nephrologist, Narayana Hrudayalaya, Bangalore, India
| | - Sachin Yalagudri
- Fellow in Electrophysiology, Narayana Hrudayalaya, Bangalore, India
| | - Bharati Das
- Fellow in Electrophysiology, Narayana Hrudayalaya, Bangalore, India
| | - A G Ravikishore
- Head of Electrophysiology and Arrhythmia Services, Narayana Hrudayalaya, Bangalore, India
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Sata Y, Schlaich MP. The Potential Role of Catheter-Based Renal Sympathetic Denervation in Chronic and End-Stage Kidney Disease. J Cardiovasc Pharmacol Ther 2016; 21:344-52. [PMID: 26740184 DOI: 10.1177/1074248415624156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 10/19/2015] [Indexed: 11/17/2022]
Abstract
Sympathetic activation is a hallmark of chronic and end-stage renal disease and adversely affects cardiovascular prognosis. Hypertension is present in the vast majority of these patients and plays a key role in the progressive deterioration of renal function and the high rate of cardiovascular events in this patient cohort. Augmentation of renin release, tubular sodium reabsorption, and renal vascular resistance are direct consequences of efferent renal sympathetic nerve stimulation and the major components of neural regulation of renal function. Renal afferent nerve activity directly influences sympathetic outflow to the kidneys and other highly innervated organs involved in blood pressure control via hypothalamic integration. Renal denervation of the kidney has been shown to reduce blood pressure in many experimental models of hypertension. Targeting the renal nerves directly may therefore be specifically useful in patients with chronic and end-stage renal disease. In this review, we will discuss the potential role of catheter-based renal denervation in patients with impaired kidney function and also reflect on the potential impact on other cardiovascular conditions commonly associated with chronic kidney disease such as heart failure and arrhythmias.
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Affiliation(s)
- Yusuke Sata
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute and the Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Markus P Schlaich
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute and the Heart Centre, Alfred Hospital, Melbourne, Australia School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
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Mauriello A, Rovella V, Anemona L, Servadei F, Giannini E, Bove P, Anselmo A, Melino G, Di Daniele N. Increased Sympathetic Renal Innervation in Hemodialysis Patients Is the Anatomical Substrate of Sympathetic Hyperactivity in End-Stage Renal Disease. J Am Heart Assoc 2015; 4:e002426. [PMID: 26611731 PMCID: PMC4845297 DOI: 10.1161/jaha.115.002426] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/29/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Renal denervation represents an emerging treatment for resistant hypertension in patients with end-stage renal disease, but data about the anatomic substrate of this treatment are lacking. Therefore, the aim of this study was to investigate the morphological basis of sympathetic hyperactivity in the setting of hemodialysis patients to identify an anatomical substrate that could warrant the use of this new therapeutic approach. METHODS AND RESULTS The distribution of sympathetic nerves was evaluated in the adventitia of 38 renal arteries that were collected at autopsy or during surgery from 25 patients: 9 with end-stage renal disease on dialysis (DIAL group) and 16 age-matched control nondialysis patients (CTRL group). Patients in the DIAL group showed a significant increase in nerve density in the internal area of the peri-adventitial tissue (within the first 0.5 mm of the beginning of the adventitia) compared with the CTRL group (4.01±0.30 versus 2.87±0.28×mm(2), P=0.01). Regardless of dialysis, hypertensive patients with signs of severe arteriolar damage had a greater number of nerve endings in the most internal adventitia, and this number was significantly higher than in patients without hypertensive arteriolar damage (3.90±0.36 versus 2.87±0.41×mm(2), P=0.04), showing a correlation with hypertensive arteriolar damage rather than with hypertensive clinical history. CONCLUSIONS The findings from this study provide a morphological basis underlying sympathetic hyperactivity in patients with end-stage renal disease and might offer useful information to improve the use of renal denervation in this group of patients.
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Affiliation(s)
- Alessandro Mauriello
- Anatomic PathologyDepartment of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
| | - Valentina Rovella
- Hypertension and Nephrology UnitDepartment of Systems MedicineUniversity of Rome Tor VergataRomeItaly
| | - Lucia Anemona
- Anatomic PathologyDepartment of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
| | - Francesca Servadei
- Anatomic PathologyDepartment of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
| | - Elena Giannini
- Anatomic PathologyDepartment of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
| | - Pierluigi Bove
- UrologyDepartment of Experimental Medicine and SurgeryUniversity of Rome Tor VergataRomeItaly
| | - Alessandro Anselmo
- Transplantation SurgeryDepartment of Surgery Policlinico Tor Vergata FoundationUniversity of Rome Tor VergataRomeItaly
| | - Gerry Melino
- BiochemistryDepartment of Experimental Medicine and SurgeryUniversity of Rome Tor VergataRomeItaly
| | - Nicola Di Daniele
- Hypertension and Nephrology UnitDepartment of Systems MedicineUniversity of Rome Tor VergataRomeItaly
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Spinelli A, Da Ros V, Morosetti D, Onofrio SD, Rovella V, Di Daniele N, Simonetti G. Technical aspects of renal denervation in end-stage renal disease patients with challenging anatomy. Diagn Interv Radiol 2015; 20:267-70. [PMID: 24378992 DOI: 10.5152/dir.2013.13408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We describe our preliminary experience with percutaneous renal denervation in end-stage renal disease patients with resistant hypertension and challenging anatomy, in terms of the feasibility, safety, and efficacy of this procedure. Four patients with end-stage renal disease patients with resistant hypertension (mean hemodialysis time, 2.3 years) who had been taking at least four antihypertensive medications underwent percutaneous renal denervation. Renal artery eligibility included the absence of prior renal artery interventions, vessel stenosis <70%, or extended calcifications (more than 30% of the vessel circumference). No cut off values of vessel diameter were used. All patients were successfully treated with no intra- or postprocedural complications, and all showed 24-hour ambulatory blood pressure reduction at the 12-month follow-up. Percutaneous renal denervation is a feasible approach for end-stage renal disease patients with resistant hypertension with encouraging short-term preliminary results in terms of procedural efficacy and safety.
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Affiliation(s)
- Alessio Spinelli
- From the Departments of Diagnostic Imaging, Molecular Imaging, Interventional Radiology, and Radiation Therapy University Hospital "Tor Vergata", Rome, Italy.
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Georgianos PI, Sarafidis PA, Zoccali C. Intradialysis Hypertension in End-Stage Renal Disease Patients: Clinical Epidemiology, Pathogenesis, and Treatment. Hypertension 2015; 66:456-63. [PMID: 26150436 DOI: 10.1161/hypertensionaha.115.05858] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 06/13/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Panagiotis I Georgianos
- From the Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital (P.I.G.) and Department of Nephrology, Hippokration Hospital (P.A.S.), Aristotle University of Thessaloniki, Thessaloniki, Greece; and CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases, Ospedali Riuniti, Reggio Calabria, Italy (C.Z.).
| | - Pantelis A Sarafidis
- From the Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital (P.I.G.) and Department of Nephrology, Hippokration Hospital (P.A.S.), Aristotle University of Thessaloniki, Thessaloniki, Greece; and CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases, Ospedali Riuniti, Reggio Calabria, Italy (C.Z.)
| | - Carmine Zoccali
- From the Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital (P.I.G.) and Department of Nephrology, Hippokration Hospital (P.A.S.), Aristotle University of Thessaloniki, Thessaloniki, Greece; and CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases, Ospedali Riuniti, Reggio Calabria, Italy (C.Z.)
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Dobrowolski LC, Bemelman FJ, Ten Berge IJM, van den Born BJH, Reekers JA, Krediet CTP. Renal denervation of the native kidneys for drug-resistant hypertension after kidney transplantation. Clin Kidney J 2014; 8:79-81. [PMID: 25713714 PMCID: PMC4310436 DOI: 10.1093/ckj/sfu134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/17/2014] [Indexed: 11/12/2022] Open
Abstract
There is a strong rationale for renal denervation (RDN) of the native kidneys in kidney transplant recipients with treatment-resistant hypertension. We present a patient with a stable graft function, who underwent RDN for posttransplant therapy-resistant hypertension (24-h ambulatory blood pressure measurement (ABPM) 143/89 mmHg, while compliantly using five different antihypertensive agents). After RDN, BP measurements and orthostatic complaints required withdrawal of two antihypertensive agents and halving a third. At 6 months, ABPM was 134/84 mmHg and allograft function remained unchanged. This case calls for designing well-designed prospective studies on RDN in kidney transplant recipients.
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Affiliation(s)
- Linn C Dobrowolski
- Department of Internal Medicine - Nephrology - Renal Transplant Unit , Academic Medical Center at the University of Amsterdam , Amsterdam , The Netherlands
| | - Frederike J Bemelman
- Department of Internal Medicine - Nephrology - Renal Transplant Unit , Academic Medical Center at the University of Amsterdam , Amsterdam , The Netherlands
| | - Ineke J M Ten Berge
- Department of Internal Medicine - Nephrology - Renal Transplant Unit , Academic Medical Center at the University of Amsterdam , Amsterdam , The Netherlands
| | - Bert-Jan H van den Born
- Department of Internal Medicine - Vascular Medicine , Academic Medical Center at the University of Amsterdam , Amsterdam , The Netherlands
| | - Jim A Reekers
- Department of Intervention Radiology , Academic Medical Center at the University of Amsterdam , Amsterdam , The Netherlands
| | - C T Paul Krediet
- Department of Internal Medicine - Nephrology - Renal Transplant Unit , Academic Medical Center at the University of Amsterdam , Amsterdam , The Netherlands
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16
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Pua U, Tan CH, Ho HH, Tan JKB, Ong PJL. Revisiting renovascular imaging for renal sympathetic denervation: current techniques and applications. Eur Radiol 2014; 25:444-53. [DOI: 10.1007/s00330-014-3392-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 07/31/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
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Di Daniele N, Rovella V, Violo L, De Francesco M, Sperandio M, Spinelli A, Tesauro M, Romeo F, Simonetti G. Reduction of left ventricular hypertrophy detected by cardiac magnetic resonance in a patient after renal denervation. J Cardiovasc Med (Hagerstown) 2014; 16:721-3. [PMID: 25010509 DOI: 10.2459/jcm.0000000000000131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Nicola Di Daniele
- aDepartment of Systems Medicine, Hypertension and Nephrology Unit bDepartment of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy cDivision of Cardiology, Department of System Medicine, Tor Vergata University, Rome, Italy
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The effect of percutaneous renal denervation on muscle sympathetic nerve activity in hypertensive patients. Int J Cardiol 2014; 176:8-12. [PMID: 25027168 DOI: 10.1016/j.ijcard.2014.06.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/27/2014] [Accepted: 06/20/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The rationale of percutaneous renal denervation (RDN) is based on extensive studies suggesting that renal nerves contribute to hypertension and that they comprise a sensible treatment target. Muscle sympathetic nerve activity (MSNA) is considered to be one of the few reliable methods to quantify central sympathetic activity. The aim of this current study is to determine the effect of RDN on MSNA in a standardized fashion. METHODS MSNA was determined in 13 patients before and 6months after RDN. Anti-hypertensive medication was stopped before MSNA. If cessation of medication was considered unsafe, a patient was instructed to use the exact same medication on both occasions. RESULTS Ten sets of MSNA recordings were of good quality for analysis. Mean age was 57 ± 3 years and mean eGFR was 85 ± 18 mL/min/1.73 m(2). MSNA was determined twice during a medication free interval in 5 patients; 1 patient used the exact same medication twice, and 4 patients used different drugs. Mean BP changed from 206 ± 7 over 116 ± 4 mmHg, to 186 ± 6 over 106 ± 3 mmHg, 6 months after RDN (p=0.06 for systolic BP, p=0.04 for diastolic BP). Mean resting heart rate did not change (p=0.44). MSNA did not change after RDN: 37 ± 4 bursts/min and 43 ± 4 bursts/min (p=0.11) at baseline and after RDN, respectively. In the 6 patients with standardized medication use during the MSNA sessions, results were comparable. CONCLUSIONS Treatment with RDN did not result in a change in MSNA. Changes in BP did not correlate with changes in MSNA.
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Persu A, Renkin J, Asayama K, O'Brien E, Staessen JA. Renal denervation in treatment-resistant hypertension: the need for restraint and more and better evidence. Expert Rev Cardiovasc Ther 2014; 11:739-49. [PMID: 23750683 DOI: 10.1586/erc.13.52] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Symplicity studies suggest that intravascular renal sympathetic nervous denervation improves blood pressure in patients with resistant hypertension, thus potentially opening a market for devices to be used when conventional drug therapy fails to restore blood pressure control. However, the size and durability of the antihypertensive, renal and sympatholytic effects of renal denervation, the long-term safety, improvement of quality of life, the possibility to relax antihypertensive drug treatment, the cost-effectiveness, and long-term hard cardiovascular-renal outcomes still remain to be firmly established. Most ongoing studies are small, industry-driven and purely observational with objectives to test new catheters and source of energy for renal nerve ablation or to search for ancillary benefits and new indications of the technique. The most urgent need, that is adequately powered randomized clinical trials testing renal denervation versus usual medical therapy delivered according to the state-of-the-art are under-represented and seldom funded by industry. The authors make a plea for a coordinated research effort in Europe. With this objective, they established collaboration with leading European experts and started the European Network for Coordinating Research on Renal Denervation. In the meantime, renal denervation should remain the ultima ratio in adherent and truly resistant patients with severe hypertension, confirmed by ambulatory monitoring, in whom secondary hypertension has been excluded and in whom all other efforts to reduce blood pressure have failed.
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Affiliation(s)
- Alexandre Persu
- Pole de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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Hoye NA, Baldi JC, Putt TL, Schollum JB, Wilkins GT, Walker RJ. Endovascular renal denervation: a novel sympatholytic with relevance to chronic kidney disease. Clin Kidney J 2014; 7:3-10. [PMID: 25859344 PMCID: PMC4389153 DOI: 10.1093/ckj/sft130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/01/2013] [Indexed: 01/20/2023] Open
Abstract
Endovascular renal denervation (sympathectomy) is a novel procedure developed for the treatment of resistant hypertension. Evidence suggests that it reduces both afferent and efferent sympathetic nerve activity, which may offer clinical benefit over and above any blood pressure-lowering effect. Studies have shown objective improvements in left ventricular mass, ventricular function, central arterial stiffness, central haemodynamics, baroreflex sensitivity and arrhythmia frequency. Benefits have also been seen in insulin resistance, microalbuminuria and glomerular filtration rate. In chronic kidney disease, elevated sympathetic activity has been causally linked to disease progression and cardiovascular sequelae. Effecting a marked reduction in sympathetic hyperactivity may herald a significant step in the management of this and other conditions. In this in-depth review, the pathophysiology and clinical significance of the sympatholytic effects of endovascular renal denervation are discussed.
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Affiliation(s)
- Neil A Hoye
- Department of Medicine , Dunedin School of Medicine , Dunedin , New Zealand
| | - James C Baldi
- Department of Medicine , Dunedin School of Medicine , Dunedin , New Zealand
| | - Tracey L Putt
- Department of Medicine , Dunedin School of Medicine , Dunedin , New Zealand
| | - John B Schollum
- Department of Medicine , Dunedin School of Medicine , Dunedin , New Zealand
| | - Gerard T Wilkins
- Department of Medicine , Dunedin School of Medicine , Dunedin , New Zealand
| | - Robert J Walker
- Department of Medicine , Dunedin School of Medicine , Dunedin , New Zealand
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Gossios TD, Ziakas A, Doumas M, Katsiki N, Petroglou D, Kouparanis A, Lillis L, Karvounis H. Renal Denervation. Angiology 2014; 65:760-8. [DOI: 10.1177/0003319713517738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Resistant hypertension, defined as failure to reach blood pressure (BP) goals despite treatment with ≥3 antihypertensive agents, one of which is a diuretic, bears a significant risk of cardiovascular complications. Strong evidence exists, implicating the overactivation of the sympathetic nervous system (SNS) in the pathogenesis of resistant hypertension through complex neurohormonal interactions. Renal denervation is a novel attractive option to achieve adequate blockade of the sympathetic system, with subsequent BP reductions in patients with resistant hypertension. Data have shown promising results regarding the efficacy of the procedure, maintaining a favorable safety profile. As such, the paradigm of resistant hypertension has expanded in other conditions involving a hyperadrenergic state such as the metabolic syndrome, heart failure, arrhythmias, sleep apnea, and renal failure. This review focuses on the pathophysiological rationale of modifying SNS tone and the evidence of the benefits of such intervention beyond BP control.
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Affiliation(s)
- Thomas D. Gossios
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Ziakas
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michalis Doumas
- 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Niki Katsiki
- 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Petroglou
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Kouparanis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Leonidas Lillis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haralambos Karvounis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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[Endovascular renal nerve ablation as a treatment for resistant hypertension]. ACTA ACUST UNITED AC 2013; 38:367-72. [PMID: 24135305 DOI: 10.1016/j.jmv.2013.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/22/2013] [Indexed: 11/22/2022]
Abstract
Radiofrequency-induced renal ablation is a non-pharmacologic therapeutic approach for the treatment of essential resistant hypertension, with a stable blood pressure lowering effect. However, data from published studies cannot conclude yet on the long-term efficacy and safety of the procedure. Therefore, the various techniques of renal nerve ablation (radiofrequency, cryoablation, ultrasounds) need further evaluation in clinical research trials. According to recent national and international recommendations, renal ablation should be reserved for patients with essential resistant hypertension.
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Kimura G. Response to Wang et al.: Mechanisms for catheter-based renal denervation to lower blood pressure: personal speculation. Hypertens Res 2013; 36:1008. [PMID: 24067891 DOI: 10.1038/hr.2013.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Genjiro Kimura
- Asahi Rosai Hospital, Japan Labour Health and Welfare Organization, Aichi, Japan
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Oosugi K, Fujimoto N, Dohi K, Machida H, Onishi K, Takeuchi M, Nomura S, Takeuchi H, Nobori T, Ito M. Hemodynamic and pathophysiological characteristics of intradialytic blood pressure elevation in patients with end-stage renal disease. Hypertens Res 2013; 37:158-65. [PMID: 24048483 DOI: 10.1038/hr.2013.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 07/30/2013] [Accepted: 08/02/2013] [Indexed: 11/09/2022]
Abstract
An increase in systolic blood pressure (SBP) after hemodialysis (intradialytic-HTN) is associated with adverse outcomes in patients on regular hemodialysis. However, the hemodynamic and Doppler echocardiographic characteristics of intradialytic-HTN and its impact on clinical outcomes are unclear. A retrospective analysis of 84 patients (45 men, 70±9 years) stratified into three groups on the basis of SBP response from pre- to post-hemodialysis: GHTN (intradialytic-HTN, SBP increase 10 mm Hg), GDROP<15 mm Hg (SBP drop <15 mm Hg), and GDROP15 mm Hg (SBP drop 15 mm Hg). Hemodynamic and echocardiographic assessments were performed pre- and post-hemodialysis, and patients were followed for 41±17 months. GHTN had higher blood glucose and lower baseline SBP, serum potassium and total cholesterol. Cardiothoracic ratio was smaller, and peak early diastolic mitral annular velocity (E') was lower in GHTN. During hemodialysis, SBP and diastolic blood pressure increased only in GHTN. After hemodialysis, left ventricular (LV) filling pressure (E/E' ratio) decreased only in GDROP15 mm Hg, resulting in a higher E/E' ratio in GHTN than GDROP15 mm Hg. Multivariate logistic regression analysis revealed a positive correlation between blood glucose and intradialytic-HTN, whereas cardiothoracic ratio, pre-hemodialysis SBP and the change in E/E' ratio with hemodialysis were negatively related to intradialytic-HTN. During follow-up, GHTN had more cardiovascular deaths than GDROP15 mm Hg (P=0.03). Multivariate Cox regression analysis showed that lower serum potassium and previous coronary artery disease, but not intradialytic-HTN, were associated with cardiovascular deaths. A higher LV afterload and elevated filling pressures after hemodialysis, indicative of increased cardiovascular stiffening and impaired diastolic filling, may contribute in part to an increased cardiovascular burden in patients with intradialytic-HTN.
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Affiliation(s)
- Kazuki Oosugi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Naoki Fujimoto
- Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hirofumi Machida
- Department of Internal Medicine, Syojunkai Takeuchi Hospital, Tsu, Japan
| | - Katsuya Onishi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Misao Takeuchi
- Department of Internal Medicine, Syojunkai Takeuchi Hospital, Tsu, Japan
| | - Shinsuke Nomura
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hideyuki Takeuchi
- Department of Internal Medicine, Syojunkai Takeuchi Hospital, Tsu, Japan
| | - Tsutomu Nobori
- Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
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Wang Y, Denton KM, Golledge J. Control of salt and volume retention cannot be ruled out as a mechanism underlying the blood pressure-lowering effect of renal denervation. Hypertens Res 2013; 36:1006-7. [DOI: 10.1038/hr.2013.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hering D, Esler MD, Schlaich MP. Chronic kidney disease: role of sympathetic nervous system activation and potential benefits of renal denervation. EUROINTERVENTION 2013; 9 Suppl R:R127-35. [DOI: 10.4244/eijv9sra22] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rubinger D, Backenroth R, Sapoznikov D. Sympathetic Nervous System Function and Dysfunction in Chronic Hemodialysis Patients. Semin Dial 2013; 26:333-43. [DOI: 10.1111/sdi.12093] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Dvora Rubinger
- Nephrology and Hypertension Services; Hadassah University; Medical Center; Jerusalem; Israel
| | - Rebecca Backenroth
- Nephrology and Hypertension Services; Hadassah University; Medical Center; Jerusalem; Israel
| | - Dan Sapoznikov
- Nephrology and Hypertension Services; Hadassah University; Medical Center; Jerusalem; Israel
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Vink EE, de Jager RL, Blankestijn PJ. Sympathetic Hyperactivity in Chronic Kidney Disease: Pathophysiology and (New) Treatment Options. Curr Hypertens Rep 2013; 15:95-101. [DOI: 10.1007/s11906-013-0328-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Canale MP, Manca di Villahermosa S, Martino G, Rovella V, Noce A, De Lorenzo A, Di Daniele N. Obesity-related metabolic syndrome: mechanisms of sympathetic overactivity. Int J Endocrinol 2013; 2013:865965. [PMID: 24288531 PMCID: PMC3833340 DOI: 10.1155/2013/865965] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/10/2013] [Indexed: 12/15/2022] Open
Abstract
The prevalence of the metabolic syndrome has increased worldwide over the past few years. Sympathetic nervous system overactivity is a key mechanism leading to hypertension in patients with the metabolic syndrome. Sympathetic activation can be triggered by reflex mechanisms as arterial baroreceptor impairment, by metabolic factors as insulin resistance, and by dysregulated adipokine production and secretion from visceral fat with a mainly permissive role of leptin and antagonist role of adiponectin. Chronic sympathetic nervous system overactivity contributes to a further decline of insulin sensitivity and creates a vicious circle that may contribute to the development of hypertension and of the metabolic syndrome and favor cardiovascular and kidney disease. Selective renal denervation is an emerging area of interest in the clinical management of obesity-related hypertension. This review focuses on current understanding of some mechanisms through which sympathetic overactivity may be interlaced to the metabolic syndrome, with particular regard to the role of insulin resistance and of some adipokines.
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Affiliation(s)
- Maria Paola Canale
- Division of Hypertension and Nephrology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Simone Manca di Villahermosa
- Division of Hypertension and Nephrology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giuliana Martino
- Division of Hypertension and Nephrology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Rovella
- Division of Hypertension and Nephrology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Annalisa Noce
- Division of Hypertension and Nephrology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Antonino De Lorenzo
- Division of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Di Daniele
- Division of Hypertension and Nephrology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
- *Nicola Di Daniele:
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Weber T, Zweiker R, Watschinger B, Grüner P, Koppelstätter C, Brandt MC, Horina J, Brussee H, Hohenstein K, Lambert T, Auer J, Hoppe UC. Clinical application of interventional renal sympathetic denervation: recommendations of the Austrian Society of Hypertension 2012. Wien Klin Wochenschr 2012. [DOI: 10.1007/s00508-012-0257-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ott C, Schmid A, Ditting T, Sobotka PA, Veelken R, Uder M, Schmieder RE. Renal denervation in a hypertensive patient with end-stage renal disease and small arteries: a direction for future research. J Clin Hypertens (Greenwich) 2012; 14:799-801. [PMID: 23126353 DOI: 10.1111/jch.12017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Sympathetic overactivity plays a crucial pathogenetic role in the maintenance and aggravation of arterial hypertension in patients with end-stage renal disease (ESRD). Renal denervation has been shown to be effective and safe in reducing blood pressure (BP) in patients with treatment-resistant hypertension; however, there are only case reports in hypertensive patients with ESRD and data are lacking about possibility of renal denervation in small renal arteries. A woman with uncontrolled treatment-resistant hypertension on chronic hemodialysis underwent bilateral native kidney, catheter-based renal denervation. Both native renal arteries were <4 mm. After 6 months without any change of antihypertensive medication or hemodialysis parameters, the authors observed a remarkable BP reduction of 38/30 mm Hg (from baseline 172/100 mm Hg to 134/70 mm Hg) as evaluated by 24-hour ambulatory BP monitoring. The authors report that renal denervation seems to be effective in controlling hypertension in patients with ESRD, even in cases of small renal arteries.
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Affiliation(s)
- Christian Ott
- Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Erlangen, Germany
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