The Sympathetic Nervous System in Chronic Kidney Disease
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.
KeywordsHypertension Chronic renal failure CKD Sympathetic nervous system Sympathetic overdrive Renal injury Ischemia Nitric oxide NO Asymmetric dimethlyarginine (ADMA)-related mechanisms Oxidative stress Ang II Renalase Pharmacotherapy Renal denervation Dialysis Hypertension
List of abbreviations
- Ang II
angiotensin receptor blocker
chronic kidney disease
end-stage renal disease
glomerular filtration rate
muscle sympathetic nerve activity
nitric oxide synthase
sympathetic nervous system.