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Renal Sympathetic Denervation

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Chronic Kidney Disease and Hypertension

Part of the book series: Clinical Hypertension and Vascular Diseases ((CHVD))

Abstract

Hypertension affects more than a quarter of the adult population worldwide and is a major risk factor for cardiovascular and kidney disease. Despite the availability of proven therapeutic approaches including lifestyle modification and the use of antihypertensive drugs, control rates for hypertension remain unsatisfactory across the globe. While the majority of patients can be controlled with adequate combination therapy of drugs with different modes of action, the phenomenon of treatment resistant hypertension, commonly defined as office blood pressure (BP) above goal despite the use of ≥ 3 antihypertensive medications at optimal doses including a diuretic, is becoming more frequent with an estimated prevalence of 8–12 % amongst hypertensive patients. While missed diagnosis of secondary forms of hypertension, physician inertia, white-coat hypertension, non-adherence with prescribed medication and others are important contributors to the phenomenon of resistant hypertension, there is a need for alternative therapeutic approaches. Renal sympathetic denervation is a recently introduced endovascular procedure that disrupts efferent and afferent renal nerves, both of which are important regulators of BP control. Limited data from several mainly uncontrolled clinical trials suggest that this catheter-based approach can be safely applied and effectively lowers BP in patients with treatment resistant hypertension, although the most recent and rigorous trial (Symplicity HTN-3) failed to demonstrate a BP reduction beyond that of a sham control. While there is accumulating evidence that renal sympathetic denervation may also have utility beyond the treatment of resistant hypertension, appropriately designed clinical trials are warranted before renal sympathetic denervation can be considered for wider clinical application.

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References

  1. World Health Organisation. Global status report on noncommunicable diseases 2010: WHO 2011.

    Google Scholar 

  2. Wolf-Maier K, Cooper RS, Kramer H, Banegas JR, Giampaoli S, Joffres MR, et al. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension. 2004;43(1):10–7.

    Article  CAS  PubMed  Google Scholar 

  3. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics-2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18–209.

    Article  PubMed  Google Scholar 

  4. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217–23.

    Article  PubMed  Google Scholar 

  5. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008;117(25):e510–26.

    Article  PubMed  Google Scholar 

  6. Daugherty SL, Powers JD, Magid DJ, Tavel HM, Masoudi FA, Margolis KL, et al. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation. 2012;125(13):1635–42.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Persell SD. Prevalence of resistant hypertension in the United States, 2003–2008. Hypertension. 2011;57(6):1076–80.

    Article  CAS  PubMed  Google Scholar 

  8. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008;51(6):1403–19.

    Article  CAS  PubMed  Google Scholar 

  9. Krause T, Lovibond K, Caulfield M, McCormack T, Williams B. Management of hypertension: summary of NICE guidance. BMJ. 2011;343:d4891.

    Article  PubMed  Google Scholar 

  10. Esler M The sympathetic system and hypertension. Am J Hypertens. 2000;13(6 Pt 2):99S−105.

    Google Scholar 

  11. Smith PA, Graham LN, Mackintosh AF, Stoker JB, Mary DA. Relationship between central sympathetic activity and stages of human hypertension. Am J Hypertens. 2004;17(3):217–22.

    Article  PubMed  Google Scholar 

  12. Esler M, Lambert G, Jennings G. Regional norepinephrine turnover in human hypertension. Clin Exp Hypertens A. 1989;11(Suppl 1):75–89.

    Article  PubMed  Google Scholar 

  13. Schlaich MP, Lambert E, Kaye DM, Krozowski Z, Campbell DJ, Lambert G, et al. Sympathetic augmentation in hypertension: role of nerve firing, norepinephrine reuptake, and Angiotensin neuromodulation. Hypertension. 2004;43(2):169–75.

    Article  CAS  PubMed  Google Scholar 

  14. DiBona GF. Physiology in perspective: the wisdom of the body. Neural control of the kidney. Am J Physiol Regul Integr Comp Physiol. 2005;289(3):R633–41.

    Article  CAS  PubMed  Google Scholar 

  15. Barajas L. Innervation of the renal cortex. Fed Proc. 1978;37(5):1192–201.

    CAS  PubMed  Google Scholar 

  16. Kopp UC. Renorenal reflexes: interaction between efferent and afferent renal nerve activity. Can J Physiol Pharmacol. 1992;70(5):750–8.

    Article  CAS  PubMed  Google Scholar 

  17. Esler M. The 2009 Carl Ludwig Lecture: pathophysiology of the human sympathetic nervous system in cardiovascular diseases: the transition from mechanisms to medical management. J Appl Physiol. 2010;108(2):227–37.

    Article  CAS  PubMed  Google Scholar 

  18. Morrissey DM, Brookes VS, Cooke WT. Sympathectomy in the treatment of hypertension; review of 122 cases. Lancet. 1953;1(6757):403–8.

    Article  CAS  PubMed  Google Scholar 

  19. Allen TR. Current status of lumbar sympathectomy. Am Surg. 1976;42(2):89–91.

    CAS  PubMed  Google Scholar 

  20. Krum H, Schlaich M, Whitbourn R, Sobotka PA, Sadowski J, Bartus K, et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet. 2009;373(9671):1275–81.

    Article  PubMed  Google Scholar 

  21. Ormiston JA, Watson T, van Pelt N, Stewart R, Haworth P, Stewart JT, et al. First-in-human use of the OneShot renal denervation system from Covidien. EuroIntervention. 2013;8(9):1090–4.

    Article  PubMed  Google Scholar 

  22. Mabin T, Sapoval M, Cabane V, Stemmett J, Iyer M. First experience with endovascular ultrasound renal denervation for the treatment of resistant hypertension. EuroIntervention. 2012;8(1):57–61.

    Article  PubMed  Google Scholar 

  23. Schmieder RE, Redon J, Grassi G, Kjeldsen SE, Mancia G, Narkiewicz K, et al. ESH position paper: renal denervation—an interventional therapy of resistant hypertension. J Hypertens. 2012;30(5):837–41.

    Article  CAS  PubMed  Google Scholar 

  24. Mahfoud F, Luscher TF, Andersson B, Baumgartner I, Cifkova R, Dimario C, et al. Expert consensus document from the European Society of Cardiology on catheter-based renal denervation. Eur Heart J. 2013;34:2149–57

    Article  PubMed  Google Scholar 

  25. Hering D, Lambert EA, Marusic P, Walton AS, Krum H, Lambert GW, et al. Substantial reduction in single sympathetic nerve firing after renal denervation in patients with resistant hypertension. Hypertension. 2013;61(2):457–64.

    Article  CAS  PubMed  Google Scholar 

  26. Symplicity HTN-1 Investigators. Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure reduction out to 24 months. Hypertension. 2011;57(5):911–7.

    Article  Google Scholar 

  27. Krum H, Schlaich M, Sobotka PA, Esler M, Mahfoud F, Bohm M, et al. TCT-12 long-term follow-up of catheter-based renal denervation for resistant hypertension confirms durable blood pressure reduction. JACC. 2012;60(17):Suppl B3.

    Article  Google Scholar 

  28. Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Bohm M. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet. 2010;376(9756):1903–9.

    Article  PubMed  Google Scholar 

  29. Esler MD, Krum H, Schlaich M, Schmieder RE, Bohm M, Sobotka PA. Renal sympathetic denervation for treatment of drug-resistant hypertension: one-year results from the Symplicity HTN-2 randomized, controlled trial. Circulation. 2012;126(25):2976–82.

    Article  CAS  PubMed  Google Scholar 

  30. Mahfoud F, Cremers B, Janker J, Link B, Vonend O, Ukena C, et al. Renal hemodynamics and renal function after catheter-based renal sympathetic denervation in patients with resistant hypertension. Hypertension. 2012;60(2):419–24.

    Article  CAS  PubMed  Google Scholar 

  31. Bhatt DL, Kandzari DE, O’Neill WW, D’Agostino R, Flack JM, Katzen BT, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med. 2014;370(15):1393–401.

    Article  CAS  PubMed  Google Scholar 

  32. Schlaich MP, Sobotka PA, Krum H, Whitbourn R, Walton A, Esler MD. Renal denervation as a therapeutic approach for hypertension: novel implications for an old concept. Hypertension. 2009;54(6):1195–201.

    Article  CAS  PubMed  Google Scholar 

  33. Schlaich MP, Socratous F, Hennebry S, Eikelis N, Lambert EA, Straznicky N, et al. Sympathetic activation in chronic renal failure. J Am Soc Nephrol. 2009;20(5):933–9.

    Article  PubMed  Google Scholar 

  34. Hering D, Mahfoud F, Walton AS, Krum H, Lambert GW, Lambert EA, et al. Renal denervation in moderate to severe CKD. J Am Soc Nephrol. 2012;23(7):1250–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Schlaich MP, Bart B, Hering D, Walton A, Marusic P, Mahfoud F, et al. Feasibility of catheter-based renal nerve ablation and effects on sympathetic nerve activity and blood pressure in patients with end-stage renal disease. Int J Cardiol. 2013;168:2214–20.

    Article  PubMed  Google Scholar 

  36. Malpas SC. Sympathetic nervous system overactivity and its role in the development of cardiovascular disease. Physiol Rev. 2010;90(2):513–57.

    Article  CAS  PubMed  Google Scholar 

  37. Brandt MC, Mahfoud F, Reda S, Schirmer SH, Erdmann E, Bohm M, et al. Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J Am Coll Cardiol. 2012;59(10):901–9.

    Article  PubMed  Google Scholar 

  38. Davies JE, Manisty CH, Petraco R, Barron AJ, Unsworth B, Mayet J, et al. First-in-man safety evaluation of renal denervation for chronic systolic heart failure: primary outcome from REACH-Pilot study. Int J Cardiol. 2013;162(3):189–92.

    Article  PubMed  Google Scholar 

  39. Lambert GW, Hering D, Esler MD, Marusic P, Lambert EA, Tanamas SK, et al. Response to quality of life after renal denervation. Hypertension. 2013;61(4):e39.

    Article  CAS  PubMed  Google Scholar 

  40. Pokushalov E, Romanov A, Corbucci G, Artyomenko S, Baranova V, Turov A, et al. A randomized comparison of pulmonary vein isolation with versus without concomitant renal artery denervation in patients with refractory symptomatic atrial fibrillation and resistant hypertension. J Am Coll Cardiol. 2012;60(13):1163–70.

    Article  PubMed  Google Scholar 

  41. Brandt MC, Reda S, Mahfoud F, Lenski M, Bohm M, Hoppe UC. Effects of renal sympathetic denervation on arterial stiffness and central hemodynamics in patients with resistant hypertension. J Am Coll Cardiol. 2012;60(19):1956–65.

    Article  PubMed  Google Scholar 

  42. Carlstedt T, Dalsgaard CJ, Molander C. Regrowth of lesioned dorsal root nerve fibers into the spinal cord of neonatal rats. Neurosci Lett. 1987;74(1):14–8.

    Article  CAS  PubMed  Google Scholar 

  43. Bengel FM, Ueberfuhr P, Schiepel N, Nekolla SG, Reichart B, Schwaiger M. Effect of sympathetic reinnervation on cardiac performance after heart transplantation. N Engl J Med. 2001;345(10):731–8.

    Article  CAS  PubMed  Google Scholar 

  44. Geisler BP, Egan BM, Cohen JT, Garner AM, Akehurst RL, Esler MD, et al. Cost-effectiveness and clinical effectiveness of catheter-based renal denervation for resistant hypertension. J Am Coll Cardiol. 2012;60(14):1271–7.

    Article  PubMed  Google Scholar 

  45. Brinkmann J, Heusser K, Schmidt BM, Menne J, Klein G, Bauersachs J, et al. Catheter-based renal nerve ablation and centrally generated sympathetic activity in difficult-to-control hypertensive patients: prospective case series. Hypertension. 2012;60(6):1485–90.

    Article  CAS  PubMed  Google Scholar 

  46. Kaltenbach B, Franke J, Bertog SC, Steinberg DH, Hofmann I, Sievert H. Renal sympathetic denervation as second-line therapy in mild resistant hypertension: a pilot study. Catheter Cardiovasc Interv. 2013;81(2):335–9.

    Article  PubMed  Google Scholar 

  47. Ott C, Mahfoud F, Schmid A, Ditting T, Sobotka PA, Veelken R, et al. Renal denervation in moderate treatment-resistant hypertension. J Am Coll Cardiol. 2013;62(20):1880–6.

    Article  PubMed  Google Scholar 

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Acknowledgments

The manuscript is supported by a Senior Research Fellowship from the National Health and Medical Research Council (NHMRC) of Australia.

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Authors and Affiliations

  1. Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia

    Markus P. Schlaich

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  1. Markus P. Schlaich
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Correspondence to Markus P. Schlaich .

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Editors and Affiliations

  1. Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland, USA

    Matthew R. Weir

  2. Section of Nephrology, University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn, Illinois, USA

    Edgar V. Lerma

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Schlaich, M. (2015). Renal Sympathetic Denervation. In: Weir, M., Lerma, E. (eds) Chronic Kidney Disease and Hypertension. Clinical Hypertension and Vascular Diseases. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-1982-6_7

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  • DOI: https://doi.org/10.1007/978-1-4939-1982-6_7

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  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4939-1981-9

  • Online ISBN: 978-1-4939-1982-6

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