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The Sympathetic Nervous System in Chronic Kidney Disease

  • Secondary Hypertension: Adrenal and Nervous System Mechanisms (S Oparil, Section Editor)
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Abstract

Accumulating evidence has shown that the sympathetic nervous system plays an important role in the pathophysiology and progression of several chronic disorders, e.g., arterial hypertension, cardiac arrhythmias, heart failure, and in particular chronic kidney disease (CKD). Experimental and clinical studies provide evidence that sympathetic inhibition using either sympatholytic pharmacotherapy or catheter-based renal denervation has beneficial effects in patients with CKD. Randomized clinical trials are needed to characterize the underlying pathophysiological mechanisms, and systematically evaluate the therapeutic effects of sympathetic inhibition in this high-risk patient population. In this review current knowledge of the role of the sympathetic nervous system in the development and progression of CKD will be summarized, and novel treatment options targeting sympathetic nervous system activity will be discussed.

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Abbreviations

ACE:

angiotensin-converting enzyme

ADMA:

asymmetric dimethlyarginine

Ang II:

angiotensin II

ARB:

angiotensin receptor blocker

BP:

blood pressure

CKD:

chronic kidney disease

ESRD:

end-stage renal disease

GFR:

glomerular filtration rate

MSNA:

muscle sympathetic nerve activity

NE:

norepinephrine

NO:

nitric oxide

NOS:

nitric oxide synthase

RAAS:

renin-angiotensin-aldosterone system

SNS:

sympathetic nervous system.

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Conflict of Interest

All authors participating have disclosed potential conflicts of interest that might cause a bias in the article. The institution has received scientific support from Medtronic/Ardian.

Michael Böhm, Roland E. Schmieder, and Felix Mahfoud were investigators in the Symplicity HTN-1 and HTN-2 trials. Christian Ukena, Michael Böhm, Roland E. Schmieder, and Felix Mahfoud have received speaker honoraria and consulting fees from Medtronic/Ardian. Christian Ukena, Michael Böhm, and Felix Mahfoud are supported by Deutsche Forschungsgemeinschaft (KFO 196). Sebastian Ewen and Felix Mahfoud are supported by Deutsche Hochdruckliga. Dominik Linz and Felix Mahfoud are supported by Deutsche Gesellschaft für Kardiologie.

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Authors and Affiliations

  1. Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, 66421, Homburg/Saar, Germany

    Sebastian Ewen, Christian Ukena, Dominik Linz, Michael Böhm & Felix Mahfoud

  2. Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany

    Roland E. Schmieder

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  1. Sebastian Ewen
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  2. Christian Ukena
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  3. Dominik Linz
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  4. Roland E. Schmieder
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  5. Michael Böhm
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  6. Felix Mahfoud
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Correspondence to Felix Mahfoud.

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Authors’ Note

Sebastian Ewen, Christian Ukena, Dominik Linz, Roland E. Schmieder, Michael Böhm, and Felix Mahfoud have substantially contributed to the interpretation of data and drafting of the article. All authors have approved the final version of the manuscript to be published.

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Ewen, S., Ukena, C., Linz, D. et al. The Sympathetic Nervous System in Chronic Kidney Disease. Curr Hypertens Rep 15, 370–376 (2013). https://doi.org/10.1007/s11906-013-0365-0

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