Sympathetic Activation in Chronic Renal Failure

Schlaich, Markus P.; Socratous, Flora; Hennebry, Sarah C.; Eikelis, Nina; Lambert, Elisabeth; Straznicky, Nora E.; Esler, Murray; Lambert, Gavin W.

doi:10.1681/asn.2008040402

Cited by 371 publications

(252 citation statements)

References 83 publications

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“…Taken together, activation of the sympathetic nervous system is an important factor in the onset and development of obesity-related renal injury, 7,20,22,23 and hence WL Renal function during weight loss K Masuo et al programs should be initiated and convey some degree of renal protection in the overweight/obese patient. Glomerular hyperfiltration, 41 hyperleptinemia, 43,44 insulin resistance 30 and stimulation of the RAS, 21,45 accompanying heightened sympathetic nervous activity, may contribute to renal injury in obesity. It has been documented that the RAS is linked to obesity and its activity is reduced in association with WL.…”

Section: Discussionmentioning

confidence: 99%

“…In many clinical and epidemiological studies, elevated sympathetic nervous activity has been documented in obesity 16 or weight gain [17][18][19] and in patients with end-stage renal disease. 7,[20][21][22] Zoccali et al 20,22 reported that the degree of sympathetic nervous activation might relate to the occurrence of fatal cardiovascular events. We also observed previously that 23 higher plasma NE levels could predict future renal injury in non-obese, normotensive individuals.…”

Section: Introductionmentioning

confidence: 99%

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Effects of weight loss on renal function in overweight Japanese men

et al. 2011

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Obesity is known as an independent risk factor for renal injury. Sympathetic nerve activation may have an important role of the pathogenesis of obesity, and hypertension may underpin the development of cardiovascular events. In the present study, we evaluated the effects of weight loss (WL) on renal function, especially focusing on sympathetic nervous activity. In 154 overweight or obese Japanese men (89 normotensive and 65 untreated mild hypertensive subjects), body weight, body mass index (BMI), total body fat mass, blood pressure (BP), serum creatinine, blood urea nitrogen, creatinine clearance (CCr) (calculated with the Cockcroft-Gault equation) and plasma norepinephrine (NE) were measured before and after a 12-month period of WL with a mild caloric-restricted diet and exercise. A significant WL was defined as 10% or more WL compared with the entry period. In total, 97 (63.0%) subjects succeeded in significant (by 14.3%) WL at 12 months, and 57 subjects (37.0%) did not succeed in significant WL but they lost 7.7% weight. At entry, levels of plasma NE, serum creatinine and fat mass were significantly lower and CCr was greater in the group with a significant WL compared with those without WL. BMI, total body fat mass and plasma NE significantly decreased, and CCr increased with WL. At both baseline and at the 12-month period, fat mass and plasma NE negatively correlated with CCr and positively correlated with creatinine at each time point. Changes in fat mass and plasma NE over 12 months correlated with changes in creatinine, and only changes in fat mass negatively correlated with changes in CCr. Basal fat mass and plasma NE correlated positively with serum creatinine at 12 months and negatively with CCr at the same time point. In multiple regression analyses, basal plasma NE and fat mass were significant determinants of serum creatinine levels and CCr at 12 months.In conclusion, WL improved renal function (as evident from measures of creatinine and CCr) in overweight individuals. Basal plasma NE levels and total body fat mass could be predictors for improvement in renal function associated with WL. Suppression of sympathetic nervous activation associated with WL may have a role in the ameliorative effects on renal function.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of weight loss on renal function in overweight Japanese men

et al. 2011

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“…Because patients undergoing hemodialysis have significantly higher sympathetic burst frequency than patients with bilateral nephrectomy, this finding has been attributed to an afferent signal arising from the failing kidney. There is now an emerging body of literature showing the independent contribution of elevated sympathetic activity and/or vagal withdrawal on LVH in ESRD (16). Norepinephrine is known to cause cardiomyocyte hypertrophy in vitro (17).…”

Section: Discussionmentioning

confidence: 99%

Determinants of Cardiac Autonomic Dysfunction in ESRD

Chan¹,

Levin²,

Chertow³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Cardiovascular events are common in patients with ESRD. Whether sympathetic overactivity or vagal withdrawal contribute to cardiovascular events is unclear. We determined the general prevalence and clinical correlates of heart rate variability in patients on hemodialysis.Design Conclusions: Holter findings in patients on hemodialysis are characterized by sympathetic overactivity and vagal withdrawal and are associated with higher LVM and impaired physical performance. Understanding the spectrum of autonomic heart rate modulation and its determinants could help to guide preventive and therapeutic strategies.

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“…Evidence has suggested that the benefit of β‐blockers for patients with NSTEMI may be due to the multivessel disease commonly presenting in them and its sympathetic hyperactivity 36, 37, 38, 39. However, further exploration of the clinical usefulness of β‐blocker therapy in patients with ACS warrants large‐scale clinical trials such as a recently registered project (NCT02648243).…”

Section: Discussionmentioning

confidence: 99%

Relationship Between β‐Blocker Therapy at Discharge and Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Sun

Shen

et al. 2016

JAHA

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BackgroundThe evidence supporting the use of β‐blockers in patients with acute coronary syndrome after successful percutaneous coronary intervention has been inconsistent and scarce.Methods and ResultsBetween March 1, 2009, and December 30, 2014, a total of 3180 eligible patients with acute coronary syndrome undergoing percutaneous coronary intervention were consecutively enrolled. The primary end point was all‐cause death and the secondary end point was a composite of all‐cause death, nonfatal myocardial infarction, heart failure readmission, and cardiogenic hospitalization. Patients were compared according to the use of β‐blockers at discharge. Compared with the no β‐blocker group, the risk of all‐cause death was significantly lower in the β‐blocker group (hazard ratio [HR], 0.33; 95% CI, 0.17–0.65 [P=0.001]). A consistent result was obtained in multiple adjusted model and propensity score–matched analysis. The use of β‐blockers was also associated with decreased risk of composite of adverse cardiovascular events (HR, 0.47; 95% CI, 0.28–0.81 [P=0.006]), although statistical significance disappeared after multivariable adjustment and propensity score matching. Furthermore, we performed post hoc analysis for the subsets of patients and the results revealed that patients with non–ST‐segment elevation myocardial infarction benefited the most from β‐blocker therapy at discharge (HR, 0.04; 95% CI, 0.00–0.27 [P=0.001]), and the use of <50% of target dose was significantly associated with better outcome compared with no β‐blocker use, rather than ≥50% of target dose.ConclusionsThe administration of relatively low β‐blocker dose is associated with improved clinical outcomes among patients with acute coronary syndrome after successful percutaneous coronary intervention, especially for patients with non‐ST‐segment elevation myocardial infarction.

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Sympathetic Activation in Chronic Renal Failure

Cited by 371 publications

References 83 publications

Effects of weight loss on renal function in overweight Japanese men

Effects of weight loss on renal function in overweight Japanese men

Determinants of Cardiac Autonomic Dysfunction in ESRD

Relationship Between β‐Blocker Therapy at Discharge and Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

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