Cardiorenal protective effects of renal denervation in chronic kidney disease

Hypertension and cardiovascular disease contribute to increased morbidity and mortality in patients with chronic kidney disease (CKD). As an interventional antihypertensive treatment, renal denervation appears to offer benefits beyond a simple blood pressure reduction. This review article will discuss the available experimental and clinical evidence on the application of renal denervation in CKD. Specifically, experimental studies suggest that renal denervation could reduce blood pressure in some but not all forms of CKD and that there is a differential contribution of the renal afferent nerves to high blood pressure in different conditions. A few clinical studies have documented a blood pressure reduction following renal denervation in CKD patients, but none of these
studies are randomized, sham-controlled trials, potentially undermining the strength of this evidence. Experimental and clinical studies show that renal denervation is not only safe for CKD patients, but may offer renoprotective effects, such as attenuation in proteinuria, glomerular, and tubular-interstitial damage and slowing down decline in kidney function, but these benefits again await further substantiation in controlled trials. There is also preliminary evidence suggesting renal denervation might improve cardiac hypertrophy and autonomic function as assessed by heart rate variability, systolic blood pressure variability, and baroreflex sensitivity, in both animal models and patients with CKD. Despite therefore significant progress in the application and understanding of the mechanisms underlying renal denervation as a therapeutic procedure, ongoing work is required to confirm whether or not proposed cardiorenal benefits are associated with a reduction in the comorbidity of cardiovascular disease in CKD populations.