Current Cardiology Reports

, Volume 14, Issue 3, pp 285–292

The Role of Renal Denervation in the Treatment of Heart Failure

  • Paul A. Sobotka
  • Henry Krum
  • Michael Böhm
  • Darrel P. Francis
  • Markus P. Schlaich
Congestive Heart Failure (J Lindenfeld, Section Editor)

DOI: 10.1007/s11886-012-0258-x

Cite this article as:
Sobotka, P.A., Krum, H., Böhm, M. et al. Curr Cardiol Rep (2012) 14: 285. doi:10.1007/s11886-012-0258-x
  • 852 Downloads

Abstract

The heart and kidney interact in terms of hemodynamics and neurohumoral regulatory mechanisms, and this helps to maintain circulatory homeostasis under normal conditions. However, the normal regulatory mechanisms become inappropriate in the setting of congestive heart failure (CHF), and significant renal dysfunction often develops in CHF patients. Activation of renal sympathetic efferent nerves causes renin release, sodium and water retention, and reduced renal blood flow, all hallmarks of the renal manifestations of CHF. An increase in plasma levels of angiotensin II that is mediated in part by renal sympathetic activation has an effect on the central nervous system to further increase global sympathetic tone. Renal sympathetic activity can be assessed clinically by renal norepinephrine spillover, and an increase in renal norepinephrine spillover in CHF predicts reduced survival. In addition to efferent sympathetic activation, activation of renal sensory nerves in CHF may cause a reflex increase in sympathetic tone that contributes to elevated peripheral vascular resistance and vascular remodeling as well as left ventricular remodeling and dysfunction. In animal models of heart failure, surgical renal denervation has been shown to improve both renal and ventricular function. Although surgical renal denervation has long been known to lower blood pressure and improve survival in patients with hypertension, the invasive nature of this approach and its associated complications has limited its appeal. However, a novel catheter-based device has recently been introduced that specifically interrupts both efferent and afferent renal nerves, and there is significant interest in the use of this device to treat both hypertension and CHF. Several ongoing clinical trials are investigating the safety and efficacy of renal denervation in patients with CHF.

Keywords

NorepinephrineSympatheticAngiotensinKidneyRenal blood flowClinical trialRenal denervationHeart failure

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Paul A. Sobotka
    • 1
    • 6
  • Henry Krum
    • 2
  • Michael Böhm
    • 3
  • Darrel P. Francis
    • 4
  • Markus P. Schlaich
    • 5
  1. 1.Medtronic, VascularSanta RosaUSA
  2. 2.Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
  3. 3.Klinik für Innere Medizin III, Universitātsklinikum des SaarlandesHomburg/SaarGermany
  4. 4.International Centre for Circulatory Health, St Mary’s Hospital and Imperial CollegeLondonUK
  5. 5.Baker IDI Heart and Diabetes InstituteMelbourneAustralia
  6. 6.PaulUSA