Chronic Kidney Disease As a Potential Indication for Renal Denervation

Abstract

Renal denervation is being used as a blood pressure lowering therapy for patients with apparent treatment resistant hypertension. However, this population does not represent a distinct disease condition in which benefit is predictable. In fact, the wide range in effectiveness of renal denervation could be a consequence of this heterogeneous pathogenesis of hypertension. Since renal denervation aims at disrupting sympathetic nerves surrounding the renal arteries, it seems obvious to focus on patients with increased afferent and/or efferent renal sympathetic nerve activity. In this review will be argued, from both a pathophysiological and a clinical point of view, that chronic kidney disease is particularly suited to renal denervation.

Keywords: chronic kidney disease; hypertension; renal denervation; renin-angiotensin-aldosterone-system; sympathetic nervous system.

Figure 1

Schematic representation of sympathetic nerve activity in CKD patients and normal subjects. The blue line represents muscle sympathetic nerve activity (MSNA) in healthy subjects, the red line represents MSNA in untreated CKD patients and the green line represents MSNA in CKD patients, when treated chronically with a RAAS-inhibitor (Ligtenberg et al., ; Klein et al., ; Neumann et al., , ; Siddiqi et al., 2011). Sympathetic activity increases with age, irrespective of treatment. The figure shows that chronic treatment with RAAS-inhibitors does not result in full normalization of MSNA. This indicates the need for additional sympatholytic therapy.