© Springer International Publishing AG 2017 307
A. Covic et al. (eds.), Resistant Hypertension in Chronic Kidney Disease,
DOI 10.1007/978-3-319-56827-0_19
Chapter 19
Devices for Neural Modulation (Renal
Denervation, Barostimulation)
Marcin Adamczak, Magdalena Bartmańska, and Andrzej Więcek
Introduction
One of the pathogenic factors of arterial hypertension in chronic kidney disease
(CKD) patients besides others like hypervolemia, increased activity of renin angio-
tensin system (RAS), or endothelial dysfunction is increased activity of the sympa-
thetic nervous system (SNS). In CKD patients, SNS overactivity may also contribute
to the pathogenesis of cardiovascular morbidity, mortality, and progression toward
end-stage kidney disease (ESKD). In this chapter, first the issue of SNS activity in
CKD patients will be briefly discussed. Next, we will review the current status of
interventional nonpharmacological methods of treatment which aim to reduce SNS
activity – such as renal denervation (RDN) and baroreflex activation therapy (BAT)
in resistant hypertension and experience with such therapies in patients with CKD.
Sympathetic Nervous System Overactivity in Chronic
Kidney Disease
Early observations of the sympathetic nervous system overactivity in CKD were
based on increased catecholamines plasma concentrations. More precisely, SNS
activity can be estimated directly by the analysis of nerve discharge of the nervus
peronaeus, i.e., by the muscle sympathetic nerve activity (MSNA) measurement.
Converse et al. in 1992 were first to report that MSNA is increased in hemodialysis
CKD patients. They showed about 2.5-fold MSNA increase in hemodialysis CKD
patients when compared to healthy subjects. In this study, it was also shown that
M. Adamczak • M. Bartmańska • A. Więcek (*)
Department of Nephrology, Transplantation and Internal Medicine,
Medical University of Silesia, Katowice, Poland
e-mail: [email protected]