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Predisposing factors to heart failure in diabetic nephropathy: a look at the sympathetic nervous system hyperactivity

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Abstract

Diabetes mellitus (DM) and heart failure (HF) are frequent comorbidities among elderly patients. HF, a leading cause of mortality and morbidity worldwide, is characterized by sympathetic nervous system hyperactivity. The prevalence of diabetes mellitus (DM) is rapidly growing and the risk of developing HF is higher among DM patients. DM is responsible for several macro- and micro-angiopathies that contribute to the development of coronary artery disease (CAD), peripheral artery disease, retinopathy, neuropathy and diabetic nephropathy (DN) as well. Independently of CAD, chronic kidney disease (CKD) and DM increase the risk of HF. Individuals with diabetic nephropathy are likely to present a distinct pathological condition, defined as diabetic cardiomyopathy, even in the absence of hypertension or CAD, whose pathogenesis is only partially known. However, several hypotheses have been proposed to explain the mechanism of diabetic cardiomyopathy: increased oxidative stress, altered substrate metabolism, mitochondrial dysfunction, activation of renin–angiotensin–aldosterone system (RAAS), insulin resistance, and autonomic dysfunction. In this review, we will focus on the involvement of sympathetic system hyperactivity in the diabetic nephropathy.

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Abbreviations

HF:

Heart failure

DM:

Diabetes mellitus

CAD:

Coronary artery disease

AF:

Atrial fibrillation

SNS:

Sympathetic nervous system

CA:

Cathecolamines

βARs:

β-adrenergic receptors

DN:

Diabetic nephropathy

CKD:

Chronic kidney disease

RAAS:

Renin–angiotensin–aldosterone system

NE:

Norepinephrine

EN:

Epinephrine

GRK2:

G-protein coupled receptor kinase 2.

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Funding

G. Rengo was supported by the Ministry of Health (Italy) Grant Number GR-2011-02346878 and by San Paolo Bank of Naples and University of Naples Federico II—STAR Program 2016.

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Authors and Affiliations

  1. Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy

    Klara Komici & Graziamaria Corbi

  2. Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy

    Grazia Daniela Femminella, Alessandro Cannavo, Leonardo Bencivenga, Dario Leosco, Nicola Ferrara & Giuseppe Rengo

  3. Center for Translational Medicine and Department of Pharmacology, Lewis Katz School of Medicine, Temple University, Philadelphia, USA

    Claudio de Lucia

  4. Istituti Clinici Scientifici Maugeri SPA - Società Benefit, IRCCS - Istituto Scientifico di Telese, Terme, BN, Italy

    Nicola Ferrara & Giuseppe Rengo

Authors
  1. Klara Komici
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  2. Grazia Daniela Femminella
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  3. Claudio de Lucia
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  4. Alessandro Cannavo
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  5. Leonardo Bencivenga
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  6. Graziamaria Corbi
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  7. Dario Leosco
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  8. Nicola Ferrara
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  9. Giuseppe Rengo
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Contributions

GR and KK contributed to the review conception and design. KK, GM F, CdL, AC and LB conducted the literature searches and reviewed the identified articles. AC and GC provided critical analysis. DL and NF revised the manuscript for intellectual content. All authors read and approved the final manuscript.

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Correspondence to Klara Komici or Giuseppe Rengo.

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Komici, K., Femminella, G.D., de Lucia, C. et al. Predisposing factors to heart failure in diabetic nephropathy: a look at the sympathetic nervous system hyperactivity. Aging Clin Exp Res 31, 321–330 (2019). https://doi.org/10.1007/s40520-018-0973-2

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  • DOI: https://doi.org/10.1007/s40520-018-0973-2

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