Mild chronic renal insufficiency induces sympathetic overactivity

Tinucci, Taís; Sb, Abrahão; Jl, Santello; Mion, Décio

doi:10.1038/sj.jhh.1001149

Cited by 43 publications

(37 citation statements)

References 25 publications

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“…Although this question has not been addressed systematically, it is tempting to speculate on several pathophysiologic possibilities. Muscle sympathetic nerve activity, for example, correlates with daytime BP variability in healthy men (8), and sympathetic nerve overactivity is a hallmark of CRF that occurs early in the course of disease (13). Irregular BP fluctuations caused by an increased sympathetic nervous tone may cause increased "noise" in the dynamic BP patterns, which may lead to apparently blunted amplitudes of the physiologic regular ultradian oscillations of BP.…”

Section: Discussionmentioning

confidence: 99%

“…As the importance of the neuroendocrine origins of hypertension in early CRF are increasingly understood (12,13), it is tempting to speculate that abnormalities in the sympathetic tone could affect not only circadian and minute-to-minute fluctuations of BP and HR but also ultradian cardiovascular rhythmicity even in mild to moderate renal failure. Such potential abnormalities may be more readily detectable in children, in whom ultradian rhythms seem to be more prominent than in adults (10).…”

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confidence: 99%

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Ultradian but not Circadian Blood Pressure Rhythms Correlate with Renal Dysfunction in Children with Chronic Renal Failure

Wühl

Hadtstein

Mehls

et al. 2005

Journal of the American Society of Nephrology

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Whereas the diurnal fall of BP (dipping) is an important prognostic marker in patients with chronic renal failure (CRF), the integrity of physiologic ultradian (i.e., shorter than 24 h) cardiovascular rhythms in patients with CRF is unknown. Also, the relationship between conventional dipping analysis and Fourier spectral rhythm analysis has not been examined in renal hypertension. The prevalence and dimensions of the circadian and three ultradian (12, 8, and 6 h) cardiovascular rhythms were studied by ambulatory BP monitoring in 214 children (aged 3 to 18 yr) with CRF (stage 2 to 4 chronic kidney disease) and no antihypertensive treatment compared with 938 healthy control subjects, and the relationship of rhythm characteristics to conventional dipping parameters, renal function, proteinuria, and serum electrolytes was assessed. The CRF cohort exhibited significantly reduced amplitudes of the circadian and all ultradian cardiovascular rhythms studied (all P < 0.01). Moreover, all BP and most heart rate rhythms showed significantly delayed acrophases (time of peak; P < 0.01). Whereas conventional BP dipping parameters (day/night difference, day/night ratio) and the 24-h BP amplitude were independent of renal function, the 8-h BP amplitude was positively correlated with GFR (r ‫؍‬ 0.3, P ‫؍‬ 0.01) and inversely correlated with the urinary protein/creatinine ratio (r ‫؍‬ ؊0.27, P < 0.05), and the 6-h BP amplitude was inversely correlated with proteinuria (r ‫؍‬ ؊0.3, P < 0.02). Children who displayed 24-or 12-h cardiovascular rhythms had significantly lower serum calcium levels than children without these rhythms. In summary, children with CRF display not only blunted circadian but also blunted ultradian cardiovascular rhythms. Ultradian but not circadian rhythms or conventional dipping parameters are quantitatively associated with renal function and proteinuria.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Ultradian but not Circadian Blood Pressure Rhythms Correlate with Renal Dysfunction in Children with Chronic Renal Failure

Wühl

Hadtstein

Mehls

et al. 2005

Journal of the American Society of Nephrology

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“…In CKD, the sympathetic hyperactivity seems to be expressed at the earliest clinical stage of the disease, showing a direct relationship with the severity of the condition of renal impairment [13][14][15][16][17]. The interruption of sympathetic hyperactivity and feedback of the renin-angiotensinaldosterone system cycle may be beneficial for this population.…”

Section: Introductionmentioning

confidence: 99%

Proof of concept study: Improvement of echocardiographic parameters after renal sympathetic denervation in CKD refractory hypertensive patients - diastolic function

Kiuchi¹,

Mion²,

Graciano³

et al. 2017

Cardiovasc Disord Med

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Aim: We evaluated the effectiveness of the renal sympathetic denervation (RSD) in diastolic heat and renal functions, in resistant hypertensive CKD patients. Methods and results:Data were obtained at baseline and monthly until 6 th month of follow-up. Twenty-six out of the 45 patients had LVH and nineteen did not present LVH. The LV mass index decreased from 123.70 ± 38.44 g/m 2 at baseline to 106.50 ± 31.88 g/m 2 at the 6 th month after RSD, P<0.0001. The comparison between baseline and the 6 th month post RSD showed that the mitral valve E deceleration time shortened from 242.40 ± 45.11 ms to 214.50 ± 36.40 ms (P<0.0001), and a significant reduction in the isovolumic relaxation time (IVRT) was noted from 126.10 ± 26.56 ms to 107.80 ± 24.53 ms (P<0.0001). Tissue Doppler imaging revealed a significant reduction in the ratio of mitral inflow velocity to annular relaxation velocity (lateral E/e'), a marker of LV diastolic filling pressure, significantly decreased from 9.49 ± 2.57 at baseline to 6.88 ± 1.96 at the 6 th month post procedure (P<0.0001). When the variation between baseline and the 6 th month post RSD in LVH patients and non LVH patients were compared to the same parameters: mitral valve E deceleration time (-29.65 ± 15.80 ms and -25.53 ± 20.04 ms, respectively, P=0.4439), the IVRT (-20.00 ± 13.78 ms and -16.05 ± 12.65 ms, respectively, P=0.3316), and mitral valve lateral E/e' ratio (-2.82 ± 1.21 and -2.32 ± 1.27, respectively, P=0.1900) no significant difference was found. Conclusion:The RSD showed an improvement of diastolic echocardiographic parameters in LVH and non LVH CKD refractory hypertensive patients.

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“…In this respect, hypertension can be a cause of and a sustaining and worsening factor in the progression of renal disease. Evidence is accumulating that activation of the sympathetic nervous system (SNS) could play a major role in the progression of CKD [15,16]. Enhanced activity of the SNS has been demonstrated in patients with CKD [16,17].…”

Section: Introductionmentioning

confidence: 99%

Electroacupuncture and Moxibustion Decrease Renal Sympathetic Nerve Activity and Retard Progression of Renal Disease in Rats

Paterno¹,

Bergamaschi

Campos

et al. 2012

Kidney Blood Press Res

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Background/Aim: Chronic kidney disease (CKD) is an increasing major public health problem worldwide. The sympathetic nervous system and nitric oxide play an important role in the pathogenesis of CKD. Traditional Chinese medicine has accumulated thousands of years of therapeutic experiences. Electroacupuncture (EA) and moxibustion (MO) are two such therapeutic strategies. The aim of this study was to investigate the renal and hemodynamic effects of EA-MO in an experimental model of a CKD. Methods: Male Wistar rats submitted to 5/6th nephrectomy (5/6 NX) were studied for 8 weeks. There were four groups: (1) control, normal rats; (2) NX, 5/6 NX only; (3) NX-AS, 5/6 NX and EA-MO session using sham points, and (4) NX-AM, 5/6 NX and EA-MO session using real acupoints. Biochemical and blood pressure studies, renal sympathetic nerve activity measurements, nitric oxide levels and the histopathological indices were assessed. Results: The EA- and MO-treated group presented significant improvement in all measured functional and histopathological parameters. Conclusion: These findings suggest that EA-MO had beneficial effects on CKD. This effect was probably achieved by the modulation of the renal sympathetic nerve activity and nitric oxide levels, leading to decreased blood pressure, which is associated with less proteinuria.

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Mild chronic renal insufficiency induces sympathetic overactivity

Cited by 43 publications

References 25 publications

Ultradian but not Circadian Blood Pressure Rhythms Correlate with Renal Dysfunction in Children with Chronic Renal Failure

Ultradian but not Circadian Blood Pressure Rhythms Correlate with Renal Dysfunction in Children with Chronic Renal Failure

Proof of concept study: Improvement of echocardiographic parameters after renal sympathetic denervation in CKD refractory hypertensive patients - diastolic function

Electroacupuncture and Moxibustion Decrease Renal Sympathetic Nerve Activity and Retard Progression of Renal Disease in Rats

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