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.
Highlights
Renal denervation (RDN) is an invasive procedure in which a catheter is percutaneously introduced into the renal arteries
When applying RDN, the assumption is that renal sympathetic nerves are too active and that this activity is the main contributor to hypertension in these patients
In an earlier study we found a positive relationship between muscle sympathetic nerve activity (MSNA) levels and blood pressure (Siddiqi et al, 2009)
Summary
Renal denervation is being used as a blood pressure lowering therapy for patients with apparent treatment resistant hypertension. This population does not represent a distinct disease condition in which benefit is predictable. 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 suited to renal denervation
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